[Surgery of macular neovascular subretinal membranes]

Vitreoretinal surgical techniques were recently used to eradicate subfoveal choroidal neovascularization which is usually associated with a poor visual prognosis. A series of 102 patients who underwent this surgery with a small retinotomy was reviewed. There were 62 eyes with age-related macular degeneration, 35 eyes with presumed ocular histoplasmosis, and five eyes with other etiologies. Retinal pigment epithelium patches were associated in seven eyes. Significant improvement in vision was achieved in 33% of eyes with age-related macular degeneration. Final visual acuity was 20/200 or worse in 84% of eyes. Visual prognosis was unchanged in eyes with retinal epithelium patches. In presumed ocular histoplasmosis, response to surgery seemed better: visual improvement was achieved in 44% of eyes and final visual acuity was 20/70 or more in 33% of eyes. During a one year follow-up, recurrent choroidal neovascularization, macular pucker and retinal detachment were observed in 27%, 11% and 5.6% of eyes respectively. Long term follow-up and randomized clinical trials comparing laser and surgical treatments are required for evaluation of surgical removal. At present, surgical removal does not reduce rates of choroidal neovascularization recurrence.