Surgical removal of subfoveal choroidal neovascular membranes in older patients without age-related macular degeneration

PURPOSE To assess visual and anatomical outcomes following the surgical removal of subfoveal choroidal neovascular membranes (CNVMs) in older patients without clinical evidence of diffuse disease of the retinal pigment epithelium (RPE). METHODS We retrospectively reviewed records of consecutive patients aged 50 years or older who underwent surgical removal of subfoveal CNVMs. Patients with clinical evidence for age-related macular degeneration (AMD) (>5 small drusen), angioid streaks, and myopic degeneration were excluded. RESULTS Twenty-two patients (8 women) ranged in age from 50 to 85 years (median, 67 years). All membranes were 100% classic, with a mean size of 2.5 MPS disc areas (range, 1 to 6.5). Best postoperative visual acuity (VA), measured a median 12.5 weeks after surgery, improved (>3 Snellen lines) in 10 eyes (45%) and worsened in 0 eyes, with 8 eyes (36%) achieving 20/50 or better. Over a mean follow-up of 37 months (range, 6 to 114 months), CNVM recurrence was seen in 13 eyes (59%), causing loss of VA from best postoperative levels in 5 eyes (23%). On final follow-up, 4 eyes (18%) retained acuity of 20/50 or better, 12 eyes (55%) had disciform scarring, and 5 eyes (23%) had geographic atrophy. Improvement in best postoperative VA occurred in a higher percentage of eyes with focal (58%) compared with idiopathic (30%) disease, but this trend was not statistically significant (p = 0.23, Fisher's exact test). CONCLUSIONS Surgical removal of subfoveal CNVMs may result in substantial visual improvement in older patients without other clinical evidence for AMD, particularly in eyes with focal diseases of the RPE-Bruch's membrane complex.