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M.W. Johnson, R.A. Wu, S. Dev; Surgical Removal of Subfoveal Choroidal Neovascular Membranes Following Photodynamic Therapy . Invest. Ophthalmol. Vis. Sci. 2005;46(13):3625.
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Purpose: To assess the outcomes of submacular surgery in patients who have previously undergone photodynamic therapy and to identify factors predictive of postoperative prognosis. Methods: We retrospectively reviewed records of consecutive patients who underwent surgical removal of subfoveal CNVM following previous photodynamic therapy. Patients with diffuse RPE disease (AMD, myopic degeneration) were excluded. Diagnoses included presumed ocular histoplasmosis (7), idiopathic CNVM (3), multifocal choroiditis (2), and birdshot chorioretinitis (1). Results: Thirteen patients (9 men) ranged in age from 20 to 78 years (median, 36 years). All CNVMs were 100% classic, with a mean size of 3.2 MPS disc areas (range, 0.75 to 16). Patients had received from 1 to 5 sessions of PDT preoperatively. Best postoperative VA improved (3 or more Snellen lines) in 7 eyes (54%) and worsened in 1 eye (8%), with 6 eyes (46%) achieving 20/50 or better. Over a mean follow–up of 15.8 months (range, 6 to 31 months), CNVM recurrence was seen in 5 eyes (38%), causing loss of VA from best postoperative levels in 1 eye (8%). Postoperative PDT was associated with excellent VA (20/25 or better) in 2 of 3 eyes. Better visual outcomes were seen in eyes with preoperative VA of 20/200 or better and in eyes with only one preoperative PDT treatment. Conclusions: Visual outcomes of submacular surgery do not appear to be significantly decreased or enhanced by prior photodynamic therapy. Patients with focal RPE disease who have "failed" one or two PDT treatments are potential candidates for submacular surgery, particularly those with VA of 20/200 or better.
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