Functional and Morphological Outcome After Macular Surgery for Retinal Angiomatous Proliferation

Abstract

Abstract: : Purpose: Retinal angiomatous proliferation (RAP) is a subgroup of neovascular age–related macular degeneration. Currently, no proven treatment modality exists for RAP. The aim of this study is to report the functional and morphological outcome of patients who underwent macular surgery for RAP. Methods: In this retrospective study, 11 eyes of 11 consecutive patients with RAP who underwent macular translocation with 360 degree retinotomy (MT–360) or extraction of the choroidal neovascularization (CNV) between April 2001 and July 2003 were included. The procedure was performed by one surgeon. All patients had a complete ocular examination including visual acuity measurement with ETDRS chart, fundus photography and fluorescein angiography at baseline and at follow–up examinations in three months intervals. Indocyanine green angiography and optical coherence tomography were available in the majority of cases. Visual acuity equivalents were converted into the logMAR units for the statistical analysis. Results: Eight patients (3 female, 5 male, mean age: 79 years) were treated by MT–360. Three patients (2 female, 1 male, mean age: 77 years) underwent extraction of the CNV. Mean follow–up of the MT–360 and CNV extraction group was 20 and 12.9 months, respectively. Mean baseline visual acuity was 20/250 (range: hand motion – 20/50). Mean visual acuity at the last follow–up examination was 20/200 (range: 20/800 – 20/40) representing an improvement of one ETDRS line. Five of the 11 patients showed improved vision. In the remaining 2 and 4 eyes visual acuity was stabilized or worsened, respectively. Postoperative retinal detachment was seen in 2 eyes requiring further surgical treatment. One eye had recurrent CNV which could be treated by laser photocoagulation. Conclusions: In the presented retrospective small–case series, MT–360 could stabilize or improve visual acuity in the majority of the eyes with RAP in a follow–up period of almost two years. CNV extraction achieved stabilization of visual acuity. However, regular follow–up examinations are necessary to detect surgery–related complications at an early stage. Further large scale trials will elucidate the role of macular surgery in the treatment of RAP.

Keywords: age-related macular degeneration • choroid: neovascularization • vitreoretinal surgery