The Swedish national survey of surgical excision for submacular choroidal neovascularization (CNV)

Abstract

ABSTRACT.Purpose: To compare the visual outcome after surgical removal of subfoveal choroidal neovascularization (CNV) in patients younger and older than 50 years of age. Methods: Patient records from all Swedish centers performing submacular CNV surgery were reviewed and 90 patients treated between 1992-1999 with a follow-up of 6 months or more were included. The results obtained in 49 patients aged 51-89 years (medianΩ72 years) with neovascular disease caused by agerelated macular degeneration (AMD) were compared with the outcome of 41 patients aged 6-49 years (medianΩ36 years) with CNV secondary to non-AMD causes. The main outcome measure was the improvement or deterioration in visual acuity (standardized in logMAR units) at 6 months following surgery. Secondary endpoints were recurrent CNV and surgical complications. Results: The level of preoperative visual acuity was not significantly different between younger patients with CNV associated with non-AMD and older patients with visual loss due to AMD (pΩ0.069). However, visual acuity at 6 months after surgery was better (pΩ0.0042) in younger patients (median improvementΩ0.19 logMAR) than in older patients (median improvementΩ0.0 log MAR). Marked visual improvement (Ͼ1 log MAR unit) was seen in 29% of non-AMD patients ∞50 years compared to 0% in the AMD group Ͼ50 years. Conclusion: Surgical removal of submacular CNV does not appear to improve visual acuity in patients Ͼ 50 years of age. However, it may be beneficial for younger patients where a substantial improvement of visual acuity is seen in a subset of these patients. Further studies are required to assess the long-term outcome.

Longterm results in surgical removal of subfoveal choroidal neovascularization in age‐related macular degeneration

“…We found a considerably lower incidence of recurrence of 6%. Although Eckardt (1996), Scheider et al (1999) and Berglin et al (2001) also presented low recurrence rates of 8À11%, we could substantiate the low recurrence with a significantly longer follow-up period. Hence, the hypothesis of Thomas et al (1992), which demands higher recurrence rates, cannot be supported…”

“…The visual outcome in our study of subretinal membrane removal in AMD is distinctly worse than in studies of surgical removal of idiopathic membranes or CNV in POHS (presumed ocular histoplasmosis syndrome), as expected (Berglin et al 2001;Lit et al 2001). This difference has been explained by larger surgical RPE defects due to multiple sites of ingrowth in CNV and by diffuse RPE disease in AMD (Thomas et al 1994).…”

“…Other authors have reported increased VA in the majority of eyes (Ormerod et al 1994;Eckardt 1996;Scheider et al 1999). In contrast, Berglin et al (2001) found no rise in VA in a series of 49 eyes, including six eyes with non-AMD-related CNV. However, we found that only two eyes regained reading vision during followup, comparable to reports by Thomas et al (1992), where reading vision was restored in one out of 22 eyes (Fig.…”

Long-term results after surgical extraction of subfoveal choroidal neovascular membranes with and without haemorrhage in age-related macular degeneration

“…Postoperatively, reduction of exudation from CNV was observed as has been reported before [13,17,6,14,4]. However, CNV extraction has been shown to result in a circumscribed RPE damage with secondary defects in the retina and choriocapillaris [20] and consecutive central scotomas [12].…”

Aktueller Stand der Iris-Pigmentepithel-Transplantation

“…Zudem haben verschiedene Studien eine Ausdehnung der Atrophiezone nach Membranextraktion sowie eine Rezidivinzidenz der Neovaskularisationsmembran von 30 bis 40% der Patienten gezeigt [4,5,8,12,17]. Die Transplantation von retinalem Pigmentepithel (RPE) in den subretinalen Raum mit dem Ziel der anatomischen and funktionellen Rekonstruktion wird seit uber 20 Jahren im Rahmen mehrerer experimenteller and klinischer Studien untersucht.…”