Author: Klaus Lucke, Bremen, Germany

Introduction:

Surgical removal of subfoveal CNVs was practiced widely in the 1990s for the treatment of AMD and other exudative maculopathies. Since it virtually always left a large subfoveal RPE defect the visual results were by and large disappointing and the Submacular Surgery Trial (SST) showed that no statistically significant improvement in vision resulted from surgical removal of CNVs. Furthermore since the introduction of intravitreal anti-VEGF therapy few retina specialists nowadays would seriously consider the option of surgical removal of a CNV.

Case description:

10 years ago we surgically removed a large hemorrhagic submacular neovascular membrane in a 43-year-old highly myopic female physician. The visual acuity at that time was reduced to 0.1 due to exudation and blood. The operation went without problems and visual acuity recovered to 0.8 two months later. The patient was subsequently lost to follow up.

Recently she returned to have her secondary cataract attended to. The visual acuity prior to the development of nuclear sclerosis had over the years remained constant at 0.8. The myopic fundus currently shows no residual signs of the submacular membrane and hemorrhage except for a small PE defect outside the vascular arcades in the area of the retinotomy.

Discussion:

Non-AMD subretinal neovascular membranes are frequently localized anterior to the pigment epithelial layer („classic“). Current treatment methods with anti-VEGF injections or PDT if effective in stopping the neovascular activity would nevertheless leave scar tissue between the photoreceptors and the pigment epithelium, severely limiting the potential for visual recovery. Surgical removal, however, can restore the PE-photoreceptor complex to its normal anatomy with consequently good visual function.

Conclusion:

In non-AMD classic CNVs surgical removal in select cases may be useful for the restoration of anatomic relationships and visual function and should be considered among the treatment options.