Long-term Results After Surgical Extraction of Subfoveal Choroidal Neovascular Membranes with and Without Haemorrhage in Age-related Macular Degeneration

Overview

Journal Graefes Arch Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2004 Jan 10

PMID 14714187

Citations 3

Authors

Ameli Gabel-Pfisterer

Jessica Laue

Heinrich Heimann

Claudia Jandeck

Ulrich Kellner

Norbert Bornfeld

Michael H Foerster

Affiliations

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Abstract

Background: Surgical extraction has been suggested as a treatment of choroidal neovascular membranes. We demonstrate the long-term results of our patients regarding complications, risk of recurrence and development of visual acuity.

Methods: We have retrospectively evaluated the charts and re-examined the patients who underwent surgical extraction of choroidal neovascular membranes (CNV) because of age-related macular degeneration (AMD) between March 1994 and December 2000 in the Department of Ophthalmology of the Benjamin Franklin Clinic, Berlin. Fifty-two eyes of 49 patients with a minimum follow-up of 12 months after pars plana vitrectomy with CNV extraction and SF6-endotamponade were included. Initially, in 15% of all eyes the lesions were obscured by intravitreal haemorrhage. All visible lesions were located subfoveally. In 40% of all eyes the lesion was predominantly classic; 21% of the lesions were predominantly occult and 23% of the lesions were comprised of more than 50% haemorrhage. The maximum follow-up was 80 months, the mean 46 months.

Results: The median initial visual acuity was 0.08 (range: hand movements to 0.4) and the median final visual acuity was not significantly different at 0.067 (range: non lux to 0.4). A loss of less than three lines of visual acuity occurred in 65.4% of our patients. During follow-up, 25% of eyes developed a rhegmatogenous retinal detachment and 19.2% of all eyes suffered from recurrence of CNV. At the end of the follow-up, three eyes (5.8%) suffered from non-treated retinal detachment and three eyes (5.8%) had recurrent CNV lesions. All eyes showed a retinal pigment epithelium defect at the site of former CNV.

Conclusion: A stabilisation of visual acuity in individual patients with CNV because of AMD can be achieved by surgical extraction, yet the defect of the RPE and the risk of complications limit the benefit. We consider the surgical extraction of CNV from AMD in patients with low initial visual acuity who are not amenable to PDT.

Citing Articles

Recurrence of choroidal neovascularisation after photodynamic therapy in patients with age-related macular degeneration.

Potter M, Szabo S Br J Ophthalmol. 2007; 91(6):753-6.

PMID: 17229805 PMC: 1955583. DOI: 10.1136/bjo.2006.110239.

The end of submacular surgery for age-related macular degeneration? A meta-analysis.

Falkner C, Leitich H, Frommlet F, Bauer P, Binder S Graefes Arch Clin Exp Ophthalmol. 2006; 245(4):490-501.

PMID: 16673139 DOI: 10.1007/s00417-005-0184-3.

[Photodynamic therapy with verteporfin for recurrent choroidal neovascularisation (CNV) following prior argon laser coagulation].

Gabel-Pfisterer A, Wehner A, Heimann H, Foerster M, Wachtlin J Ophthalmologe. 2005; 102(6):592-6.

PMID: 15662503 DOI: 10.1007/s00347-004-1146-6.

References

Berglin L, ALGVERE P, Olivestedt G, Crafoord S, Stenkula S, Hansson L . The Swedish national survey of surgical excision for submacular choroidal neovascularization (CNV). Acta Ophthalmol Scand. 2002; 79(6):580-4. DOI: 10.1034/j.1600-0420.2001.790607.x. View

Lopez P, Grossniklaus H, Lambert H, AABERG T, Capone Jr A, Sternberg Jr P . Pathologic features of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol. 1991; 112(6):647-56. DOI: 10.1016/s0002-9394(14)77270-8. View

. Verteporfin therapy of subfoveal choroidal neovascularization in age-related macular degeneration: two-year results of a randomized clinical trial including lesions with occult with no classic choroidal neovascularization--verteporfin in.... Am J Ophthalmol. 2001; 131(5):541-60. DOI: 10.1016/s0002-9394(01)00967-9. View

Scheider A, Gundisch O, Kampik A . Surgical extraction of subfoveal choroidal new vessels and submacular haemorrhage in age-related macular degeneration: results of a prospective study. Graefes Arch Clin Exp Ophthalmol. 1999; 237(1):10-5. DOI: 10.1007/s004170050187. View

Eckardt C, Eckardt U, Conrad H . Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration. Graefes Arch Clin Exp Ophthalmol. 1999; 237(4):313-25. DOI: 10.1007/s004170050239. View

de Juan Jr E, MACHEMER R . Vitreous surgery for hemorrhagic and fibrous complications of age-related macular degeneration. Am J Ophthalmol. 1988; 105(1):25-9. DOI: 10.1016/0002-9394(88)90116-x. View

Berger A, Kaplan H . Clinical experience with the surgical removal of subfoveal neovascular membranes. Short-term postoperative results. Ophthalmology. 1992; 99(6):969-75; discussion 975-6. DOI: 10.1016/s0161-6420(92)31869-x. View

Eckardt C . [Surgical removal of submacular neovascularization membranes]. Ophthalmologe. 1996; 93(6):688-93. DOI: 10.1007/s003470050059. View

Ormerod L, Puklin J, Frank R . Long-term outcomes after the surgical removal of advanced subfoveal neovascular membranes in age-related macular degeneration. Ophthalmology. 1994; 101(7):1201-210. DOI: 10.1016/s0161-6420(94)31200-0. View

10.

Aisenbrey S, Lafaut B, Szurman P, Grisanti S, Luke C, Krott R . Macular translocation with 360 degrees retinotomy for exudative age-related macular degeneration. Arch Ophthalmol. 2002; 120(4):451-9. DOI: 10.1001/archopht.120.4.451. View

11.

. Subfoveal neovascular lesions in age-related macular degeneration. Guidelines for evaluation and treatment in the macular photocoagulation study. Macular Photocoagulation Study Group. Arch Ophthalmol. 1991; 109(9):1242-57. View

12.

Tsujikawa M, Sawa M, Lewis J, Motokura M, Tsujikawa K, Ohji M . Chorioretinal damage caused by the excision of choroidal neovascularization. Am J Ophthalmol. 1998; 126(3):348-57. DOI: 10.1016/s0002-9394(98)00089-0. View

13.

Bressler N, Bressler S, Hawkins B, Marsh M, Sternberg Jr P, Thomas M . Submacular surgery trials randomized pilot trial of laser photocoagulation versus surgery for recurrent choroidal neovascularization secondary to age-related macular degeneration: I. Ophthalmic outcomes submacular surgery trials pilot study report.... Am J Ophthalmol. 2000; 130(4):387-407. DOI: 10.1016/s0002-9394(00)00729-7. View

14.

MACHEMER R, Steinhorst U . Retinal separation, retinotomy, and macular relocation: II. A surgical approach for age-related macular degeneration?. Graefes Arch Clin Exp Ophthalmol. 1993; 231(11):635-41. DOI: 10.1007/BF00921957. View

15.

Thomas M, Dickinson J, Melberg N, Ibanez H, Dhaliwal R . Visual results after surgical removal of subfoveal choroidal neovascular membranes. Ophthalmology. 1994; 101(8):1384-96. DOI: 10.1016/s0161-6420(94)31172-9. View

16.

Wolf S, Lappas A, Weinberger A, Kirchhof B . Macular translocation for surgical management of subfoveal choroidal neovascularizations in patients with AMD: first results. Graefes Arch Clin Exp Ophthalmol. 1999; 237(1):51-7. DOI: 10.1007/s004170050194. View

17.

Thomas M, Grand M, Williams D, Lee C, Pesin S, Lowe M . Surgical management of subfoveal choroidal neovascularization. Ophthalmology. 1992; 99(6):952-68; discussion 975-6. DOI: 10.1016/s0161-6420(92)31888-3. View

18.

Akduman L, Karavellas M, MacDonald J, Olk R, Freeman W . Macular translocation with retinotomy and retinal rotation for exudative age-related macular degeneration. Retina. 1999; 19(5):418-23. DOI: 10.1097/00006982-199909000-00009. View

19.

Muller S, Ehrt O, Gundisch O, Scheider A . [Functional results after surgical extraction or photocoagulation of choroid neovascularization (CNV) in age-related macular degeneration]. Ophthalmologe. 2000; 97(2):142-6. DOI: 10.1007/s003470050024. View

20.

Bressler N . Photodynamic therapy of subfoveal choroidal neovascularization in age-related macular degeneration with verteporfin: two-year results of 2 randomized clinical trials-tap report 2. Arch Ophthalmol. 2001; 119(2):198-207. View