Daniel P Joseph1, Akinori Uemura, Matthew A Thomas. 1. Barnes Retina Institute and Department of Ophthalmology, Washington University School of Medicine, 1600 South Brentwood Boulevard, 8th Floor, St. Louis, MO 63144, USA. josephd@vision.wustl.edu
Abstract
PURPOSE: To report visual outcome, rate of recurrence, and complications for patients who underwent subretinal surgery as treatment of classic juxtafoveal choroidal neovascularization (CNV). METHODS: This study was a noncomparative case series of 46 patients who underwent subretinal surgery for juxtafoveal CNV that appeared to be pure classic without angiographic or clinical evidence of occult neovascularization between 1993 and 2000, with best-corrected preoperative and postoperative Snellen visual acuity reported. RESULTS: The mean follow-up period +/- SD was 20.4 +/- 12.9 months (range, 6-57 months). Etiologic categories included ocular histoplasmosis syndrome (37%), age-related macular degeneration (20%), idiopathic (15%), myopic degeneration (11%), mixed features of ocular histoplasmosis syndrome and myopia (11%), and other miscellaneous causes (6%). Thirty-three percent (15) of 46 eyes that underwent surgery had previously been treated with thermal laser photocoagulation at least once. Most patients (89%) had membranes with the posterior edge located 200 microm or closer to the center of the foveal avascular zone. The median preoperative visual acuity was 20/70 compared with the median postoperative visual acuity of 20/40. Significant improvement of visual acuity, measured as an increase of two or more lines of vision, occurred in 26 eyes (56%). In 10 (22%) of the remaining eyes, postoperative visual acuity was within one line of the preoperative visual acuity. Visual acuity decreased by two to five lines in seven eyes (15%). Severe vision loss, defined as a decrease of six or more lines, occurred in three eyes (7%). Recurrence was observed in 26 patients (56.5%). CONCLUSION: The results indicated that subretinal surgery for juxtafoveal CNV improved or stabilized vision in most cases (78%), but in the absence of controls with a limited number of eyes and variable follow-up, it is impossible to determine with certainty if this improvement or stabilization is greater than what might be seen with laser photocoagulation or observation.
PURPOSE: To report visual outcome, rate of recurrence, and complications for patients who underwent subretinal surgery as treatment of classic juxtafoveal choroidal neovascularization (CNV). METHODS: This study was a noncomparative case series of 46 patients who underwent subretinal surgery for juxtafoveal CNV that appeared to be pure classic without angiographic or clinical evidence of occult neovascularization between 1993 and 2000, with best-corrected preoperative and postoperative Snellen visual acuity reported. RESULTS: The mean follow-up period +/- SD was 20.4 +/- 12.9 months (range, 6-57 months). Etiologic categories included ocular histoplasmosis syndrome (37%), age-related macular degeneration (20%), idiopathic (15%), myopic degeneration (11%), mixed features of ocular histoplasmosis syndrome and myopia (11%), and other miscellaneous causes (6%). Thirty-three percent (15) of 46 eyes that underwent surgery had previously been treated with thermal laser photocoagulation at least once. Most patients (89%) had membranes with the posterior edge located 200 microm or closer to the center of the foveal avascular zone. The median preoperative visual acuity was 20/70 compared with the median postoperative visual acuity of 20/40. Significant improvement of visual acuity, measured as an increase of two or more lines of vision, occurred in 26 eyes (56%). In 10 (22%) of the remaining eyes, postoperative visual acuity was within one line of the preoperative visual acuity. Visual acuity decreased by two to five lines in seven eyes (15%). Severe vision loss, defined as a decrease of six or more lines, occurred in three eyes (7%). Recurrence was observed in 26 patients (56.5%). CONCLUSION: The results indicated that subretinal surgery for juxtafoveal CNV improved or stabilized vision in most cases (78%), but in the absence of controls with a limited number of eyes and variable follow-up, it is impossible to determine with certainty if this improvement or stabilization is greater than what might be seen with laser photocoagulation or observation.
Authors: Wai-Man Chan; Timothy Y Y Lai; Yasuo Tano; David T L Liu; Kenneth K W Li; Dennis S C Lam Journal: Jpn J Ophthalmol Date: 2006 Mar-Apr Impact factor: 2.211