Surgical excision of subfoveal neovascular membranes

Subfoveal choroidal neovascular membranes (CNV) are a cause of significant visual impairment. Laser treatment of such lesions results in visual loss. Surgical excision of CNV may allow stabilisation or improvement of vision. A series of results of surgical excision are presented.

The records for 43 eyes of 40 consecutive patients undergoing surgical excision of CNV not associated with age-related macular degeneration (AMD) were reviewed retrospectively. Statistical analyses of the relationship between pre-operative factors and post-operative visual results were made. Improvement or worsening of visual acuity was defined as a change of more than 2 lines of Snellen acuity.

In 79.1% of patients visual acuity was improved or unchanged following surgery, and in 20.9% there was a reduction of Snellen acuity. There was no statistically significant association between visual outcome and age, gender, duration of visual symptoms, cause of CNV, presence of subretinal haemorrhage, elevation of retina by subretinal fluid, prior laser surgery, or the presence of pre-operative or intraoperative subretinal haemorrhage. There was a possible association between the non-use of gas tamponade and an increased chance of reduced vision. Visual loss was more likely in those eyes with good pre-operative visual acuity. Recurrence of CNV was noted in 10 (23%) eyes; repeat surgery was not associated with a worse visual outcome.

Surgical excision of CNV not related to AMD is a promising technique. More meaningful assessment of visual function in these patients will allow refinement of case selection.