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Surgical removal of large subretinal neovascular membranes: results and complications
1Department of Ophthalmology, Medical Faculty of the Comenius University, Bratislava, Slovak Republic.
Abstract:
Over the period from June 1992 to January 1994, six subretinal neovascular membranes were removed in our department. In five patients the damaged membranes were caused by age-related macular degeneration and in one patient the cause was choroiditis of unclear etiology. The diameter of the membranes ranged between 3 and 20 mm. The largest membrane was removed translimbally after previous lensectomy. In all patients internal silicone oil tamponade was performed. Subretinal hemorrhage was the most common peroperative complication observed. Early postoperatively, transitory corneal edema and serofibrinous reaction were recorded in some patients. Cataract formation in connection with the silicone oil tamponade, chronic uveitis, formation of epi- and subretinal membranes, retinal pigment epithelium and choroidal atrophy were also subsequently observed. Relevant additional operations were performed with the exception of one patient with internal silicone oil tamponade and cortical cataract who refused all further procedures. After a follow-up period of 24-36 months, one eye atrophied. In one eye retinal detachment in one large subretinal membrane, in one atrophy of the pigment epithelium and in another epiretinal membranes under silicone oil were present. The visual acuity achieved is 0 in two eyes and it ranged between light perception and 0.5/60. Removal of large subretinal neovascular membranes is feasible, but the results are not justified by the surgeon's effort and the patient's psychic stress.
Insights
Surgical removal of subretinal neovascular membranes is possible but challenging. The procedure carries significant risks and complications, with limited visual acuity outcomes, questioning the overall benefit versus patient and surgeon burden.
Area of Science:
- Ophthalmology
- Retinal Surgery
- Macular Degeneration
Background:
- Subretinal neovascular membranes (SNM) are a serious cause of vision loss.
- Age-related macular degeneration (AMD) and choroiditis are primary causes of SNM.
- Surgical intervention for SNM is complex and carries risks.
Purpose of the Study:
- To evaluate the feasibility and outcomes of surgical SNM removal.
- To assess complications and visual acuity following SNM excision.
- To determine the risk-benefit ratio of this surgical procedure.
Main Methods:
- Retrospective analysis of six patients undergoing SNM removal between June 1992 and January 1994.
- Procedures included translimbal removal for large membranes and lensectomy.
- All patients received internal silicone oil tamponade; complications and visual acuity were monitored.
Main Results:
- Subretinal hemorrhage was the most common intraoperative complication.
- Postoperative complications included corneal edema, uveitis, cataract formation, and new membrane growth.
- Long-term follow-up revealed retinal detachment, pigment epithelium atrophy, and poor visual acuity (ranging from light perception to 0.5/60).
Conclusions:
- Surgical removal of large SNM is technically feasible.
- The procedure is associated with significant complications and limited visual recovery.
- The substantial surgical effort and patient stress may not be justified by the achieved outcomes.