[Functional results after surgical extraction or photocoagulation of choroid neovascularization (CNV) in age-related...

SLO microperimetric examination after the extraction of choroidal neovascular membranes (CNV) in age-related macular degeneration (AMD) shows absolute scotoma in the area of pigment epithelial loss. Laser treatment also causes complete functional loss. The functional results of these two methods should be compared before the surgical procedure is expanded.

Five eyes of five patients with large subfoveal well-defined CNV were treated by photocoagulation following the MPS criteria. Functional results were compared with similar phenotypes from a group of 78 patients operated upon. Before and after the treatment visual acuity was tested following the ETDRS criteria. The need for magnification for reading was tested using the ZEISS charts. Fundus-controlled microperimetry was performed using the scanning laser ophthalmoscope (Rodenstock) to detect deep and relative scotomata.

The recurrence rate (OP 2/5; ALK 1/5) was normal regarding the small number of patients. Visual results are slightly better in patients operated on (mean: pre 0.08; 6 weeks 0.09; 3 month 0.13; last 0.13) than in laser-treated patients (mean: pre 0.06; 6 weeks 0.07; 3 months 0.08; last 0.12). Deep scotoma can be reduced with surgical extraction of the CNV (mean factor: 6 weeks 0.6; last control 0.8) while laser treatment of the margins enlarges the scotoma (mean factor: 6 weeks 2.3; last control 2.2).

Because of the minimal functional advantages of the surgical procedure we do not think it is the method of first choice. For both methods the treatment of well-defined CNV increases the possibility of low-vision rehabilitation.