Surgery improved visual acuity in patients with peripapillary CNV

Patients with extensive peripapillary choroidal neovascularization secondary to age-related macular degeneration may benefit from surgery involving the removal of the neovascular complex, according to a small study by researchers in Germany.

Sabine Aisenbrey, MD, and colleagues at the University of Tuebingen evaluated the functional and physical effects of subretinal surgery performed on eight consecutive patients.

In all cases, surgeons performed pars plana vitrectomy and extracted the choroidal neovascular lesion through a small retinotomy at the lesion's edge. "Retinotomy is created at the peripheral edge of the CNV complex parallel to the nerve fiber course aiming to minimize nerve fiber damage," the authors said.

In addition to the vitrectomy, two patients also underwent cataract extraction and IOL implantation, the authors noted.

At 26 months mean follow-up, the researchers found that best corrected visual acuity had improved in six of the eight patients and had stabilized in one patient. The one remaining patient had a deterioration in BCVA, according to the study.

Additionally, CNV reoccurred in one patient 2 years after surgery and one other patient experienced a retinal detachment 5 years postoperatively.

Overall, mean BCVA improved from 20/63 preoperatively to 20/40 at final follow-up, according to the study.

"In this small case series of [peripapillary choroidal neovascularization], functional improvement was achieved after surgery in the majority of patients," the authors said.

"Randomized controlled studies seem to be justified to evaluate further the beneficial effect and long-term functional outcome of this therapy approach," they said.

This study is published in the August issue of British Journal of Ophthalmology.