LONG-TERM OUTCOMES AFTER THE SURGICAL REMOVAL OF ADVANCED SUBFOVEAL NEOVASCULAR MEMBRANES IN AGE-RELATED MACULAR DEGENERATION

Background: The poor results of laser photocoagulation in patients wit h age-related macular degeneration who have subfoveal neovascular memb ranes, as reported by the Macular Photocoagulation Study Group, have p osed the question as to whether the surgical removal of the neovascula r membranes by subfoveal surgery might provide superior functional res ults, possibly in subgroups of patients.Methods: The authors' first te n patients treated by subfoveal surgery were followed prospectively. F ollow-up of a mean duration of 2 years is presented, with particular e mphasis on visual and anatomic outcomes. Preoperative subfoveal choroi dal neovascular membranes and postoperative retinal pigment epithelial defects were measured using digitized planimetry. Results: Initial vi sual acuities were equal to or less than 20/400, with a mean duration of visual loss of 8 months. The mean choroidal neovascular membrane si ze was 7 disc areas. Eight of ten patients improved one to two lines o f Snellen visual acuity postoperatively. One patient achieved visual a cuity of 20/60 at 15 months before declining because of recurrent neov ascularization. Surgically induced retinal pigment epithelial defects were invariable; the mean defect was 14 standard disc areas in size. C horiocapillaris atrophy and focal losses of deeper choroidal tissue al so occurred. Surgical complications were frequent but responded to rou tine management. The authors observe a 2-year recurrence rate of 40%. Recurrences often are atypical, fibrous, and poorly vascularized. Conc lusions: Although substantial visual improvements are common, long-ter m reading vision has not been achieved. Retinal pigment epithelial inc orporation into late subfoveal membranes remains a major limiting fact or. The role of early surgery and the role of surgery for patient subg roups need to be compared directly with the results of foveal laser tr eatment, using several visual outcomes.