Original Article
Chorioretinal damage caused by the excision of choroidal neovascularization

https://doi.org/10.1016/S0002-9394(98)00089-0Get rights and content

Abstract

PURPOSE: To determine whether choroidal neovascularization excision causes mechanical damage to the neurosensory retina, retinal pigment epithelium, or choriocapillaris.

METHODS: Prospectively, 18 eyes of 18 consecutive patients who underwent choroidal neovascularization excision were observed. Preoperatively and postoperatively, the integrity of the choriocapillaris circulation in the pathway of choroidal neovascularization extraction was studied by fluorescein and indocyanine green angiography. Using static scanning laser ophthalmoscope microperimetry, the presence of iatrogenic scotomas that developed postoperatively in the pathway of choroidal neovascularization extraction was also investigated.

RESULTS: Postoperatively, a choriocapillaris defect was detected in 17 (94.4%) of 18 cases. In 15 cases (83.3%), the choriocapillaris defect had a clear relationship to the pathway of choroidal neovascularization extraction. Postoperatively, a scotoma was present in 16 (88.9%) of 18 cases. In 14 cases (77.8%), the location of the scotoma had a clear relationship to the pathway of choroidal neovascularization extraction.

CONCLUSION: Surgical excision of choroidal neovascularization leads to severe damage of the choroid and retina in the pathway of the extracted choroidal neovascularization. The injury involves the neurosensory retina, retinal pigment epithelium, and choriocapillaris.

Section snippets

Patients and methods

We studied 18 eyes of 18 consecutive patients who underwent choroidal neovascularization excision at Osaka University Hospital from June 1994 to September 1995. All patients met the following eligibility criteria: (1) evident and well-demarcated choroidal neovascularization by slit-lamp fundus biomicroscopy, fluorescein angiography, and/or indocyanine green angiography; (2) choroidal neovascularization extending under the center of the fovea (subfoveal type choroidal neovascularization) or to

Results

The group of patients studied included 13 men and five women. Their average age was 61.2 ± 13.9 (mean ± SD) years (range, 27 to 78 years). The cause of choroidal neovascularization was age-related macular degeneration in 14 cases and was idiopathic in four cases. The choroidal neovascularization was subfoveal in 13 cases and juxtafoveal in five cases. Table 1shows baseline patient characteristics. The mean follow-up was 20.1 ± 6.8 months. The preoperative mean logMAR visual acuity was 1.04 ±

Discussion

In patients with choroidal neovascularization of various causes, especially as a result of age-related macular degeneration, primary retinal pigment epithelium dysfunction and an associated choriocapillaris circulation defect are present, which may lead to damage to the overlying retina.9 Therefore, damage of the retina in the area that corresponds to excised choroidal neovascularization may have been present preoperatively. To evaluate the mechanical damage caused by surgery, we chose to study

Cited by (15)

  • Retinal pigment epithelial cell transplantation after subfoveal membranectomy in age-related macular degeneration: Clinicopathologic correlation

    2001, American Journal of Ophthalmology
    Citation Excerpt :

    There is incomplete resurfacing of the retinal pigment epithelium defect after surgical excision of a choroidal neovascular membrane in age-related macular degeneration,22,23 and damage to or removal of the retinal pigment epithelium leads to choriocapillaris atrophy in animal models.38–45 Although choroidal neovascular membrane excision can cause mechanical damage to the outer retina and choriocapillaris,46 removal of the native retinal pigment epithelium during submacular surgery may lead to secondary atrophy of the subfoveal choriocapillaris in some eyes, if it has not already occurred.36 Retinal pigment epithelium transplantation may prevent or reverse postoperative atrophy of the subfoveal choriocapillaris and improve the visual prognosis in this disease.36

View all citing articles on Scopus
View full text