Surgical removal of juxtafoveal and extrafoveal choroidal neovascularization in age-related macular degeneration

PURPOSE: In the treatment of age-related macular degeneration (AMD), the effect on the fovea of photocoagulation of juxtafoveal choroidal neovascularization(CNV) and extrafoveal CNV near the fovea has been of concern, and so usefulness of surgical excision of CNV was evaluated. SUBJECTS AND METHODS: Fifteen eyes with AMD that underwent removal of juxtafoveal CNV and extrafoveal CNV near the fovea and had been followed for over one year were included in this study. Eligibility criteria were preoperative visual acuity of 0.3 or less and evidence of CNV activity by fundus angiography. RESULTS: Visual acuity of 0.4 or more was obtained in 60% of the eyes with best visual acuity and 47% with final visual acuity. The mean best visual acuity was 0.51 in cases with Gass type 2, 0.51 in type 1 + 2 CNV, and 0.21 in type 1 CNV. Good post-operative visual acuity was obtained in type 2 and 1 + 2 cases with type 2 CNV at the foveal side accompanied by preoperative foveal retinal sensitivity of 25 dB or more. There was little improvement of visual acuity in type 1 CNV because the retinal pigmented epithelium defect occurred at the fovea. CONCLUSION: For juxtafoveal CNV and extrafoveal CNV near the fovea in AMD, type 2 and 1 + 2 cases with type 2 CNV at the foveal side are thought to be candidates for surgery. Especially, relatively good postoperative visual acuity was obtained in cases with preoperative foveal retinal sensitivity of 25 dB or above. Active surgical removal is thought to be indicated for these cases.