The surgical removal of subfoveal choroidal neovascularization - Ingrowth site as a predictor of visual outcome

Purpose: The authors determine the significance of location of the ingrowth site of subfoveal choroidal neovascularization (CNV) as a preoperative indicator of postsurgical visual acuity. Design: A retrospective review is given of preoperative fluorescein angiograms and color fundus photographs for 84 eyes with subfoveal CNV due to the following etiologies: presumed ocular histoplasmosis syndrome (POHS) = 67 eyes; multifocal choroiditis = 9 eyes; idiopathic = 8 eyes. The ingrowth site of the subfoveal CNV was classified as identifiable or not identifiable. If identifiable, the ingrowth site was further classified as extrafoveal, juxtafoveal, or subfoveal. Correlations between CNV ingrowth site location and postoperative visual acuity were made. Results: The ingrowth site for subfoveal CNV was identifiable preoperatively in 60 eyes (71%). Of 31 eyes with an extrafoveal ingrowth site, 18 (60%) had a final visual acuity of 20/40 or better. Of 12 eyes with a juxtafoveal ingrowth site and 18 eyes with a subfoveal ingrowth site, only 2 (7%) had a final visual acuity of 20/40 or better. If the ingrowth site was not identifiable or identifiable and subfoveal in location (N = 42), 76% of eyes had a final visual acuity of 20/200 or worse. Conclusion: The ingrowth site of subfoveal CNV can be identified in the majority of eyes with POHS, multifocal choroiditis, or idiopathic membranes. A significant number of subfoveal CNV will have an extrafoveal ingrowth site. Eyes with an extrafoveal ingrowth site have a favorable visual prognosis after the surgical removal of the CNV. If the ingrowth site is subfoveal or not identifiable, the visual prognosis after surgery is guarded.