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Surgery for subfoveal membranes in myopia, angioid streaks, and other disorders
D A Adelberg1, L V Del Priore, H J Kaplan
1Department of Ophthalmology and Visual Sciences Washington University School of Medicine, St. Louis, Missouri, USA.
Objective:
A retrospective analysis of patients who underwent surgical removal of subfoveal neovascular membranes caused by factors other than age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS) was performed.
Methods:
17 eyes (16 patients) were identified in which subfoveal neovascularization was caused by myopic degeneration (5 eyes), angioid streaks (5 eyes of 4 patients), idiopathic neovascularization (4 eyes), punctate inner choroidopathy (1 eye), multifocal choroiditis (1 eye), or candida chorioretinitis (1 eye).
Results:
Visual acuity remained stable after surgery in 10 of 17 eyes (59%), improved by 2 or more Snellen lines in 6 eyes (35%) and decreased in 1 eye (6%). Preoperative visual acuity was 20/80 or better in only 1 of 17 eyes (6%), but 5 of 17 eyes (29%) achieved postoperative visual acuity of 20/80 or better. Intraoperative and postoperative complications included peripheral retinal tears (1 eye), peripheral rhegmatogenous retinal detachment (1 eye), and mild cataract formation (1 eye). Subretinal neovascularization recurred after surgical removal in 4 eyes, 2 of which underwent repeat surgery.
Conclusion:
Visual acuity remained stable or improved in 94% of eyes after surgical removal of subfoveal neovascularization, but postoperative visual acuity better than 20/80 was achieved in a minority of eyes.
Insights
Surgical removal of subfoveal neovascular membranes, excluding age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS), stabilized or improved vision in 94% of eyes. However, achieving better than 20/80 vision post-surgery was uncommon.
Area of Science:
- Ophthalmology
- Retinal Diseases
- Surgical Interventions
Background:
- Subfoveal neovascular membranes can cause vision loss from various conditions.
- Exclusion of age-related macular degeneration (AMD) and presumed ocular histoplasmosis syndrome (POHS) allows focus on other etiologies.
- Surgical intervention for these membranes is considered when conservative treatments fail.
Purpose of the Study:
- To evaluate the outcomes of surgical removal of subfoveal neovascular membranes.
- To assess visual acuity changes and complications in patients undergoing this surgery.
- To identify the efficacy of surgical intervention for non-AMD/POHS related subfoveal neovascularization.
Main Methods:
- Retrospective analysis of 17 eyes (16 patients) with subfoveal neovascularization.
- Causes included myopic degeneration, angioid streaks, idiopathic neovascularization, punctate inner choroidopathy, multifocal choroiditis, and candida chorioretinitis.
- Surgical removal of the membranes was the primary intervention.
Main Results:
- Visual acuity remained stable in 59% and improved in 35% of eyes post-surgery.
- Preoperative visual acuity of 20/80 or better was present in only 6% of eyes, while 29% achieved this post-surgery.
- Complications included retinal tears, detachment, and cataract formation. Recurrence of neovascularization occurred in 4 eyes.
Conclusions:
- Surgical removal of subfoveal neovascularization offers a high rate of vision stabilization or improvement (94%).
- While vision is often preserved or enhanced, achieving excellent visual acuity (better than 20/80) is less common.
- The procedure carries risks of complications and recurrence, necessitating careful patient selection and follow-up.