Subretinal surgery for choroidal neovascularization in patients with high myopia

Objective: To analyze the visual outcome in patients undergoing surgical re moval of subfoveal choroidal neovascularization (CNV) in eyes with high myo pia. Methods: We retrospectively reviewed the medical records of 48 consecutive patients with high myopia (greater than or equal to 6 diopters [D]) who und erwent vitrectomy with surgical removal of subfoveal CNV. The patient popul ation consisted of 2 groups. Group 1 included 23 patients with findings onl y of myopic degeneration, and group 2 included 25 patients with presumed oc ular histoplasmosis sydrome and myopia of 6 D or more. Results: In group I, the visual acuity improved by 2 or more Snellen lines in 9 eyes (39%), decreased in 8 eyes (35%), and remained unchanged in 6 (26 %), with a mean follow-up of 24 months (range, 8-60 months). The preoperati ve visual acuity was 20/40 or better in only 1 eye (4%), but 8 (35%) achiev ed a final visual acuity of 20/40 or better. In group 2, the visual acuity improved in 16 eyes (64%), was stable in 4 (16%), and deteriorated in 5 (20 %), with a mean follow-up of 18 months (range, 6-44 months). Only 3 eyes (1 2%) had a preoperative visual acuity of 20/40 or better, but 11 (44%) achie ved a final visual acuity of 20/40 or better. Recurrence occurred in 13 (57 %) of the 23 eyes in group 1 and in 9 (36%) of the 25 eyes in group 2. Univ ariate analysis demonstrated a significant relation between younger patient age (group 1) and absence of postoperative CNV recurrence (group 2) and an improvement of visual acuity (P<.01). Conclusions: Surgical removal of CNV malt provide visual benefit in selecte d cases of subfoveal CNV associated with high myopia. The determination of whether surgical intervention is appropriate in these cases requires a pros pective, randomized, clinical trial.