Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study

Background: The surgical extraction of subfoveal choroidal new vessels (CNV ) is one of several possibilities to treat subfoveal CNV or haemorrhages in age-related macular degeneration (ARMD). Methods: Prospective study, follo w-up 3-6 months. Clinical and angiographic differentiation of three subgrou ps: (1) subfoveal. well-defined CNV (24 eyes); (2) subfoveal ill-defined CN V with or without well-defined components (IO eyes); (3) submacular haemorr hages (20 eyes). Results: The mean and median visual acuity and the proport ion of eyes with greater than or equal to 20/200 vision increased slightly in group 1 and decreased slightly in group 2; the differences were not sign ificant. Group 3 demonstrated mean improvement but was heterogeneous, depen ding on the site and type of underlying CNV. The proportion of eyes with 3 or more lines of improvement after 3 months was 35.3% (7/17), 10% (1/10) an d 38.9% (7/18) respectively. The proportion of eyes with a loss of 3 or mor e lines after 3 months was 5.9% (1/17), 20% (2/10) and 5.6% (1/18) respecti vely. The recurrence rate was 29.2% (7/24), 8.3% (1/11) and 25% (5/20). Int raoperative complications were iatrogenic central tears in 7.3% (4/55), per ipheral tears in 14.5% (8/55) and peripheral retinal detachment in 3.6% (2/ 55). A postoperative retinal detachment was observed in 2 of 55 eyes (3.6%) . All these complications could be managed without ill effect. Conclusion: Subfoveal surgery might perserve remaining retinal function in eyes with we ll-defined CNV. However, subgroups of the MPS subfoveal laser trials with c omparable initial visual acuity demonstrated postoperative functional stabi lisation and similar recurrence rates in well-defined CNV. Though selected cases of submacular haemorrhage did profit from surgery, TPA-assisted gas i njection will probably be a better alternative. Unfortunately, surgery for ill-defined CNV, found in the vast majority of eyes with exudative ARMD, se ems to worsen the natural course. Surgery has to be combined with restorati on of Bruch's membrane before it can become a possible therapeutic option i n ARMD.