Surgical removal of subfoveal choroidal neovascularization: visual outcome and prognostic value of fluorescein angiography and optical coherence tomography

PURPOSE. To study the functional results of macular surgery and determine pre-operative features associated with better final visual outcome. METHODS. Forty-two consecutive patients underwent surgical removal of subfoveal choroidal neovascularization (CNV), related to age-related macular degeneration (AMD) in 8 eyes, degenerative myopia in 14 eyes, multifocal choroiditis (MFC) In 10 eyes, idiopathic CNV in 6 eyes and other etiologies in 4 eyes. Mean age was 49 years. Pre-operative visual acuity (VA) was 20/200 or less in 30 eyes (71.4%) and never better than 20/40. Fluorescein angiography was analyzed before and after surgery. Pre-operative optical coherence tomographs (OCT) were studied in a masked fashion. Mean follow-up was 12 months (range 4-48 months). RESULTS. Final VA was 20/200 or less in 25 eyes (60%). According to the CNV etiology, the percentage were 87.5%, 80%, 57.1% and 20% respectively in eyes with AMD, MFC, high myopia, and idiopathic or other diseases. Post-operative VA improved in 21 eyes (50%) but subsequently declined in 7% by the final examination. Patients younger than 50 years had better functional results (p=0.006). Lack of retinal pigment epithelium (RPE) changes on pre-operative angiography was correlated with good visual outcome (p <0.001). The OCT study confirmed some features already described and showed some different CNV patterns: above and usually separated from the RPE, below and not separated from the RPE, and ungradable. Eyes with the first OCT pattern had the best visual outcome. Main complications included 4 (10%) retinal detachments and 9 (21%) recurrences. OCT was also useful to confirm CNV recurrences post-operatively. CONCLUSIONS. CNV surgical excision results vary depending on the underlying disease, the RPE and choriocapillaris function, and the features observed on pre-operative OCT images.