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J Tang, EP Shakin; Choroidal Neovascularization After Vitrectomy Surgery for Macular Disease . Invest. Ophthalmol. Vis. Sci. 2002;43(13):2524.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: The purpose of this study was to evaluate the formation of choroidal neovascular membrane (CNVM) after technically successful macular surgery for macular holes and/or epiretinal membranes. Our six patients represent the largest case series ever reported for a single institution. Methods: This was a retrospective case series in which we studied 6 eyes in 6 patients who developed CNVM following macular surgery. All patients were symptomatic with clinically significant macular pathology at the time of treatment. Patients were evaluated with Snellen visual acuity, biomicroscopy, and fluorescein angiography (FA) at baseline. All patients underwent standard pars plana vitrectomy with membrane peeling. None of the six patients had any reported intraoperative complications. In the postop period, eyes were evaluated for the absence/presence of macular pathology. The eyes in our study, with their subsequent formation of CNVM following surgery, were evaluated by clinical exam and FA. Appropriate treatment for the CNVM, including focal laser, transpupillary thermotherapy and photodynamic therapy, were utilized. Results: The prevalence of CNVM formation after macular surgery at our institution was 6 out of 374 (1.6%) patients from a period of May 1994 to June 2001. The time period for the formation of CNVM developed from 2.8 months to 21 months after vitrectomy in these patients. Preoperatively, 2 eyes had macular holes and 4 eyes had epiretinal membranes. Of the 6 eyes, 1 had clinical evidence of dry age related macular degeneration. In the postoperative period, 1 eye developed a foveal cyst just prior to the formation of CNVM. Only 3 of the 6 eyes demonstrated changes of the retinal pigment epithelium (RPE). Of those 3 eyes, 2 developed post-operative RPE mottling and 1 developed RPE atrophy with resulting window defects on FA. In subgroup analysis, 4 eyes formed subfoveal CNVM and 2 eyes formed juxtafoveal CNVM. The classification of CNVM, as determined by FA, included 1 case of pure classic, 2 cases of predominately classic and 3 cases of predominately occult CNVM. The size of the CNVM, measured in disc diameters, ranged from 0.5 to 2 disk diameters. Only 3 of the 6 eyes demonstrated any RPE mottling and window defects on FA after macular surgery. Conclusion: CNVM appears to be a rare but significant complication of macular surgery. CNVM can develop in eyes with or without macular degeneration. There may be a causal relationship between vitrectomy for macular disease and the development of CNVM. Further research is needed to evaluate the possible mechanisms and risk factors that lead to formation of CNVM after macular surgery.
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