[Senile macular degeneration: surgical management and histopathologic features]

Choroidal neovascularization often complicates senile macular degeneration; argon and krypton laser photocoagulation are very useful to stop visual acuity decrease caused by extrafoveal choroidal neovascular membrane (NVM) in a large group of patients. Unfortunately, in a large number of cases, NVM causes haemorrhagic serous detachment, disciform scar and, sometimes, vitreous hemorrhage. In these patients it is impossible to perform laser treatment. A three ports pars-plana vitrectomy has been performed for the treatment of intravitreal hemorrhage in a case of haemorrhagic disciform lesion and in two cases of extensive subretinal haemorrhage secondary to subretinal NVMs. Posterior pole focal retinotomies have been created to remove the NVMs in order to prevent further hemorrhages; an internal tamponade has been performed and the retinotomies closed with endophotocoagulation or endocryo. The specimen of the membranes, stained for light microscopy, have been studied. During the months of follow-up (9 months) no subretinal membrane no retinal detachment developed but fibrosis at the retinotomy sites led to traction on the macula. The functional aim of this surgery is limited to the restoration of a clear vitreous and to a reduction in the diameter of the central scotoma in the cases of a recent subretinal haemorrhage.