CHOROIDAL HYPOPERFUSION AFTER SURGICAL EXCISION OF SUBFOVEAL NEOVASCULAR MEMBRANES IN AGE-RELATED MACULAR DEGENERATION

Purpose. To study the choroidal circulation after surgical excision of subfoveal choroidal neovascular membranes (SFCNVM) in age-related mac ular degeneration (ARMD). Methods. Twelve eyes of eleven patients with ARMD that underwent surgical excision of SFCNVMs were evaluated with stereoscopic color fundus photography, stereoscopic fluorescein angiog raphy (FA) and scanning laser ophthalmoscope-indocyanine green videoan giography (SLO-ICGv). The patients were followed for a mean of 7.9 mon ths (range 2 to 14 months). Results. Preoperatively, all eyes had angi ographic evidence of a SFCNVM, with SLO-ICGv showing the presence of a choriocapillary blush. Postoperatively, stereoscopic color fundus pho tographs documented that the bed of the surgical excision was characte rized by an absence of visible retinal pigment epithelial (RPE) pigmen tation in all eyes. Stereoscopic FA of the excision bed revealed chori ocapillary hypofluorescence with visible dye perfusion in the underlyi ng medium and large choroidal vessels in all eyes. SLO-ICGv of the exc ision bed disclosed the presence of perfused medium and large choroida l vessels, but a marked choroidal hypofluorescence with loss of the ch oriocapillary and small choroidal vascular filling within the excision bed in eleven of the twelve eyes. Conclusion. Our results indicate th at both choriocapillary and small choroidal vascular filling is freque ntly abnormal or absent in the bed of surgically excised subfoveal neo vascular membranes in ARMD. This finding, which may represent either p athologic or iatrogenic choriocapillary and small choroidal vascular a trophy or occlusion with preservation of perfusion in the underlying m edium and large choroidal vessels, may influence structural and visual recovery after submacular surgery for ARMD, despite RPE transplantati on or regeneration.