S. Muller et al., Functional results after surgical extraction and photocoagulation of well-defined CNV in AMD patients, OPHTHALMOLO, 97(2), 2000, pp. 142-146
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.