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A. Pirbhai, T.G. Sheidow; Submacular Surgery: Effect of Age on Visual Outcome in Treatment of Non–ARMD Related CNVM . Invest. Ophthalmol. Vis. Sci. 2006;47(13):4672.
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© ARVO (1962-2015); The Authors (2016-present)
To explore the relationship of patient age on visual outcomes in patients undergoing surgical removal of choroidal neovascular membranes (CNVM) due to causes other than age related macular degeneration (ARMD).
Retrospective case review for all surgical cases of CNVM removal due to non–ARMD causes done by one surgeon over a 2 year period. Primary outcome measure was best corrected Snellen visual acuity. Comparisons were made between two sub–groups of patients: those who were older than 55 years of age and those who were younger than 55 years of age.
A total of 35 eyes from 34 patients underwent submacular surgery for juxtafoveal/subfoveal CNVM due to non–ARMD causes. Etiology of CNVM included presumed ocular histoplasmosis syndrome (POHS), idiopathic, myopic degeneration, multifocal choroiditis and trauma, respectively. Median age was 41 years (11–84) with 11 patients over age of 55 years and 24 patients under age of 55 years. Median follow–up time was 97 weeks (range, 20–200). Surgical removal of the membrane led to an improvement in final best corrected visual acuity (BCVA) at least 2 Snellen lines better in 19 of the 35 eyes (54.3%) with a mean change of 2.4 ± 0.9 lines. The mean change in BCVA for patients receiving surgery younger than 55 years of age was 3.92 ± 1.03 lines of improvement while patients over 55 years of age showed a mean of –0.91 ± 1.26 lines of improvement post–surgery. The difference in final visual outcomes between the two groups was 4.83 ± 1.75 lines (p–value = 0.01). 11 of 35 eyes (31.4%) had recurrent membranes following initial surgical removal (10 from patients under 55 years). Eyes that had recurrent membranes gained at least 2 lines of Snellen vision in 4 of 10 cases (40.0%). Patients with poorer preoperative vision (less than 20/200) gained 2.06 ± 1.83 lines more than those with 20/200 or better preoperative vision (p–value = 0.27). Combined analysis, however, show age and preoperative vision to have a statistically significant impact on final vision. There were very few intra– and post–operative complications.
Younger patient age has a statistically significant impact on visual outcome after submacular surgery for non–ARMD related CNVM, regardless of membrane recurrence. Submacular surgery in patients under 55 years of age offers excellent chances for visual improvement while in those over 55 years, surgical intervention has a high rate of visual loss from baseline.
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