98th Annual Meeting DOG 2000

P 764

Subretinal resection of the choroidal neovascularizations in cases of age-related macular degeneration (AMD)

J. Schmidt, L. Hesse, P. Kroll

Background: Age related macular degeneration (AMD) is a common cause for an irreversible loss of the ability to read. In the treatment of exsudative AMD different approaches are possible. The surgical treatment with maculardislocation are discussed but only done in a few eyecenters because of the complex treatment. The pars plana vitrectomy (PPV) with the simple extraction of choroidal neovascularizations (CNV) can be easily done and provide large macular scares.

Material and Methods: Since 1995 we operated 53 eyes with simple membranextraction caused from AMD. Patients age ranged from 58 to 85 years (mean 72 years). Pre- and postoperative we asked patients about current history of the disease, performed vision tests, angiographies with sodium fluorescein (FAG) and indocyanin green (ICG), focal ERG and microperimetry. Follow-up time ranged from 3 to 32 months (mean 16,3 months).

Results: Preoperative vision was 0.11 (range: hand movements to 0.4). Postoperative vision at the end of the follow up period was 0.12 ( range HM to 0.7). In 51 eyes a non exudative form of AMD developed and two eyes had a recurring CNV, which were removed successfully with a secon PPV. Postoperativly the centralscotomas reduced in 10 of 15 eyes which was seen by microperimetry.

Conclusions: In most cases of AMD with CNV a subretinal removal of the CNV by PPV allows a stabilization of the visual function and inhibits the development of large macular scars. Reading vision can only be achieved in rare cases. CNV larger then 2 optic nerve head diameter resolving pigment epithelial defects with choroidal atrophies limit visual rehabilitation. Macular dislocation maybe gain better visual results in this cases.

Zentrum für Augenheilkunde der Philipps-Universität, Robert- Koch- Str. 4, D-35037 Marburg