Functional results after surgical extraction and photocoagulation of well-defined CNV in AMD patients

Background: SLO microperimetric examination after the extraction of choroid al neovascular membranes (CNV) in age-related macular degeneration (AMD) sh ows absolute scotoma in the area of pigment epithelial loss. Laser treatmen t also causes complete functional loss. The functional results of these two methods should be compared before the surgical procedure is expanded. Methods and patients: Five eyes of five patients with large subfoveal well- defined CNV were treated by photocoagulation following the MPS criteria. Fu nctional results were compared with similar phenotypes from a group of 78 p atients operated upon. Before and after the treatment visual acuity was tes ted following the ETDRS criteria. The need for magnification for reading wa s tested using the ZEISS charts. Fundus-controlled microperimetry was perfo rmed using the scanning laser ophthalmoscope (Rodenstock) to detect deep an d relative scotomata. Results: The recurrence rate (OP 2/5; ALK 1/5) was normal regarding the sma ll number of patients. Visual results are slightly better in patients opera ted on (mean: pre 0.08; 6 weeks 0.09; 3 month 0.13; last 0.13) than in lase r-treated patients (mean: pre 0.06; 6 weeks 0.07; 3 months 0.08; last 0.12) . Deep scotoma can be reduced with surgical extraction of the CNV (mean fac tor: 6 weeks 0.6; last control 0.8) while laser treatment of the margins en larges the scotoma (mean factor: 6 weeks 2.3; last control 2.2). Conclusions: Because of the minimal functional advantages of the surgical p rocedure we do not think it is the method of first choice. For both methods the treatment of well-defined CNV increases the possibility of low-vision rehabilitation.