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Good long-term results observed after surgically removing extensive peripapillary choroidal neovascularization

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In the long term, removing extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome may be visually beneficial and more preferable than photoablation in selected cases, a retrospective study suggests.

"Given the likelihood of multiple treatments with photodynamic therapy or anti-vascular endothelial growth factor therapies, surgical removal provides a potentially efficacious treatment with low recurrence rates and good visual results," the authors said.

Arghavan Almony, MD, and colleagues evaluated long-term visual outcomes after performing pars plana vitrectomy and surgically removing extensive peripapillary choroidal neovascularization associated with presumed ocular histoplasmosis syndrome from 40 eyes of 35 patients who were deemed ineligible for laser treatment.

Median patient age was 34.5 years, and follow-up averaged 68 months.

Of 40 total eyes, 23 eyes with subfoveal extension of peripapillary choroidal neovascularization had baseline best corrected visual acuity that ranged from 20/25 to counting fingers at 2 feet (median, 20/200). Of these eyes, 18 had achieved stable or improved BCVA from baseline to final postop examination; five eyes had decreased by two or more lines of BCVA, the authors noted.

Final postoperative BCVA for these eyes ranged from 20/15 to counting fingers at 2 feet (median, 20/50) and had improved to 20/40 or better in 11 of 23 eyes.

Among 17 eyes in which choroidal neovascularization had remained extrafoveal, preoperative BCVA ranged from 20/20 to 20/400 (median, 20/60), according to the study.

In these eyes, final BCVA ranged from 20/20 to 20/200 (median, 20/20).

At final follow-up, BCVA had remained stable or improved from baseline in 15 eyes; BVCA had decreased by two or more lines in two eyes.

Overall, a BCVA of 20/40 or better was achieved in 14 of 17 eyes, according to the study, published in the March issue of Ophthalmology.