Subretinal endophotocoagulation in the treatment of choroidal neovascularization

The development of subfoveal choroidal neovascularization is a major cause of visual loss in age-related macular degeneration and other disorders of the retinal pigment epithelium-Bruch's membrane complex. We designed a new subretinal laser delivery system and used it to treat subfoveal neovascular membranes in three eyes with age-related macular degeneration. Preoperative visual acuities were 20/200, 20/80, and 20/300, respectively. With a mean follow-up of seven months, postoperative visual acuities were 20/80, 20/400, and 20/300, respectively. One eye developed recurrent neovascularization, which was adequately treated with slit lamp-delivered laser photocoagulation. Another eye continued to lose visual acuity because of progressive atrophy of the retinal pigment epithelium. Although ablation of choroidal neovascular membranes was possible with this technique, visual results were disappointing, probably because of damage of the underlying retinal pigment epithelium and choriocapillaris.