Surgical removal of subfoveal choroidal neovascularization in age-related macular degeneration

Objective: To assess the results of surgical excision of subfoveal choroida l neovascularization (CNV) in patients with age-related macular degeneratio n (AMD). Design: Retrospective, interventional, noncomparative case series. Participants and intervention: Sixty-four consecutive patients undergoing s urgical removal of AMD-related subfoveal CNV were studied. The surgical met hod included a small retinotomy, subretinal tissue plasminogen activator (t -PA), perfluoro-n-octane, and air-fluid exchange. Main Outcome Measures: Final Visual acuity was the main outcome measure; su rgical complications and recurrence rates were also assessed. Results: Preoperative visual acuity ranged from 20/100 to 1/200, with a mea n of 20/400. Average follow-up was 19 months. The best acuity achieved afte r surgery ranged from 20/20 to hand motions, with a mean of 20/200. Final V isual acuity ranged from 20/50 to light perception, with a mean of 20/400. Final acuity was improved 3 or move lines in 19 eyes (30%) (median, 5 lines ), stable in 27 eyes (42%), and 3 or move lines worse in 18 eyes (28%) (med ian, 4 lines). Factors associated with greater visual improvement included poorer initial acuity, larger CNV size, and smaller subretinal hemorrhage. Analysis of groups similar to Macular Photocoagulation Study subgroups A th rough D showed an average improvement of 1 line for group C (visual acuity, 20/200 or worse; CNV larger than 2 disc areas), Other preoperative, intrao perative, and postoperative factors, including recurrence and retinal detac hment, did not have a significant effect on final visual outcome. Conclusions: After surgical excision of AMD-related subfoveal CNV, vision i mproved or stabilized in the majority of patients. Surgery may be of greate st value for patients with poorer vision, larger subfoveal CNV, and minimal hemorrhage, Further evaluation of this technique should be accomplished vi a completion of a controlled, randomized multicenter study.