Surgical removal of subfoveal choroidal neovascularization: visual outcomeand prognostic value of fluorescein angiography and optical coherence tomography

PURPOSE. To study the functional results of macular surgery and determine p re-operative features associated with better final visual outcome. METHODS. Forty-two consecutive patients underwent surgical removal of subfo veal choroidal neovascularization (CNV), related to age-related macular deg eneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choro iditis (MFC) In 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 o r less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiogra phy was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 mo nths (range 4-48 months). RESULTS. Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in ey es with AMD, MFC, high myopia, and idiopathic or other diseases. Post-opera tive VA improved in 21 eyes (50%) but subsequently declined in 7% by the fi nal examination. Patients younger than 50 years had better functional resul ts (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-opera tive angiography was correlated with good visual outcome (p <0.001). The OC T study confirmed some features already described and showed some different CNV patterns: above and usually separated from the RPE, below and not sepa rated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachmen ts and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively. CONCLUSIONS. CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.