Subretinal Surgery for Choroidal Neovascularization in Patients With High Myopia

Abstract

To analyze the visual outcome in patients undergoing surgical removal of subfoveal choroidal neovascularization (CNV) in eyes with high myopia. Methods: We retrospectively reviewed the medical records of 48 consecutive patients with high myopia (Ն6 diopters [D]) who underwent vitrectomy with surgical removal of subfoveal CNV. The patient population consisted of 2 groups. Group 1 included 23 patients with findings only of myopic degeneration, and group 2 included 25 patients with presumed ocular histoplasmosis syndrome and myopia of 6 D or more. Results: In group 1, 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 preoperative visual acuity was 20/40 or better in only 1 eye (4%), but 8 (35%) achieved 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 (12%) had a preoperative visual acuity of 20/40 or better, but 11 (44%) achieved 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. Univariate 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 (PϽ.01). Conclusions: Surgical removal of CNV may provide visual benefit in selected cases of subfoveal CNV associated with high myopia. The determination of whether surgical intervention is appropriate in these cases requires a prospective, randomized, clinical trial.

Recent trends in the management of maculopathy secondary to pathological myopia

“…The Subretinal Surgery Trial group reported no benefit of surgical excision in patients with ocular histoplasmosis and idiopathic CNV, and marginal benefit for the subgroup of patients with a VA of 20/100 or worse [67]. Overall, recurrence rates of CNV are high, ranging between 18 and 57% in most studies, and visual demise is not uncommon [68][69][70]. There is at present therefore little evidence to support the surgical excision of CNV in PM.…”

Myopic choroidal neovascularization treated by intravitreal bevacizumab: comparison of two different initial doses

“…Different therapeutic approaches have been tried for myopic CNV, including argon laser photocoagulation [2,3], surgery [4,5], and photodynamic therapy with verteporfin (PDT) alone [6][7][8], or associated with intravitreal triamcinolone acetonide injection [9][10][11].…”

Intravitreous bevacizumab to treat subfoveal choroidal neovascularization in highly myopic eyes: short-term results

“…Myopic maculopathy is the main cause of vision loss among highly myopic patients, and the leading aetiology of subfoveal choroidal neovascularization (CNV) among patients younger than 50 years of age. 1 Different therapeutic approaches have been tried to treat myopic CNV, including argon laser photocoagulation, 2,3 surgical removal, and macular translocation, 4,5 and, more recently, photodynamic therapy (PDT) with verteporfin. [6][7][8] Visual deterioration secondary to retinal pigment epithelium (RPE) and choriocapillaris atrophy, and the frequent need to repeat PDT sessions have lead to the association of intravitreal triamcinolone and PDT.…”