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Surgical treatment of peripapillary choroidal neovascularisation

Abstract

Objective: To report the functional and morphological outcome of surgical treatment of peripapillary choroidal neovascularisation due to age-related macular degeneration.

Methods: Consecutive interventional case series of eight patients with extensive peripapillary choroidal neovascularisation and accompanying haemorrhage who underwent subretinal surgery including extraction of the neovascular complex. Ophthalmic examination, including visual acuity testing, colour photography and fluorescein angiography, was performed at baseline and at 3, 6, 9 and 12 months, and then yearly.

Results: Mean follow-up was 26 months (12–60 months). Preoperative best corrected visual acuity (BCVA) ranged from logMAR (logarithm of minimum angle of acuity) 1.0 (20/200) to logMAR 0.0 (20/20), with a mean of logMAR 0.5 (20/63). Mean postoperative BCVA was logMAR 0.3 (20/40). BCVA improved in six patients, was stable in one patient and deteriorated in one patient. Two years after surgery, one patient developed recurrence of the CNV that was removed surgically. One patient showed retinal detachment 5 years after subretinal surgery.

Conclusions: In this small case series of PPCNV, functional improvement was achieved after surgery in the majority of patients. Surgical extraction of the CNV represents an alternative treatment option in eyes with vision-threatening extensive PPCNV. Randomised controlled studies seem to be justified to evaluate further the beneficial effect and long-term functional outcome of this therapy approach.

  • AMD, age-related macular degeneration
  • BCVA, best corrected visual acuity
  • BRVO, branch retinal vein occlusion
  • CNV, choroidal neovascularisation
  • ETDRS, Early Treatment Diabetic Retinopathy Study
  • logMAR, logarithm of minimum angle of acuity
  • MPSG, Macular Photocoagulation Study Group
  • PDT, photodynamic therapy
  • PPCNV, peripapillary choroidal neovascularisation
  • RPE, retinal pigment epithelium
  • VEGF, vascular endothelial growth factor

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