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R.A. Wu, M.W. Johnson, D.C. Musch; Surgical Removal of Subfoveal Choroidal Neovascular Membrane in Older Patients Without Age-Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2003;44(13):4860.
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Purpose: To assess visual and anatomical outcomes following the surgical removal of subfoveal choroidal neovascular membrane (CNVM) in older patients without clinical evidence of diffuse RPE disease. Methods: We retrospectively reviewed records of consecutive patients aged 50 years or older who underwent surgical removal of subfoveal CNVM. Patients with age-related macular degeneration (AMD) (> 5 small drusen) or angioid streaks were excluded. Diagnoses included idiopathic (11 eyes), presumed ocular histoplasmosis (6), peripapillary CNVM (2), birdshot chorioretinopathy (1), idiopathic central serous chorioretinopathy (1), and multifocal choroiditis (1). Results: Twenty-one patients (7 women) ranged in age from 50 to 85 years (median, 67 years). All membranes were 100% classic, with a mean size of 2.25 MPS disc areas (range, 1 to 6.5). Best postoperative visual acuity improved (≥ 3 Snellen lines) in 10 eyes (48%) and worsened in 0 eyes, with 8 eyes (38%) achieving 20/50 or better. Over a mean follow-up of 36 months (range, 6 to 90 months), CNVM recurrence was seen in 13 eyes (62%), causing loss of visual acuity from best postoperative levels in 5 eyes (24%). On final follow-up, 4 eyes (19%) retained acuity of 20/50 or better, 12 eyes (57%) had disciform scarring, and 3 eyes (19%) had geographic atrophy. Improvement in best postoperative visual acuity occurred in a higher percentage of eyes with focal (64%) compared with idiopathic (30%) disease, but this trend was not statistically significant due to small sample size (p = 0.20, Fisher’s exact test). Conclusions: Surgical removal of subfoveal CNVM may result in substantial visual improvement in older patients without other clinical evidence for AMD, particularly in eyes with focal diseases of the RPE-Bruch’s membrane complex. More effective treatments for recurrent CNVM should increase the frequency and stability of postoperative visual gain associated with this procedure.
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