Submacular surgery for subfoveal choroidal neovascular membranes in patients with presumed ocular histoplasmosis
A. S. Berger, M. Conway, L. V. Del Priore, R. S. Walker, J. S. Pollack and H. J. Kaplan
Barnes Retina Institute, Washington University, St Louis, Mo., USA. bergera@am.seer.wustl.edu
OBJECTIVE: To determine the visual results, recurrence rates, and
postoperative complications of surgical removal of subfoveal choroidal
neovascularization (CNV) in patients with the presumed ocular
histoplasmosis syndrome. DESIGN: A consecutive surgical series of 63 eyes
of 62 patients with subfoveal CNV and the presumed ocular histoplasmosis
syndrome with longer than 6 months of follow-up. SETTING: Tertiary care
university medical center. METHODS: Patients underwent surgical removal of
subfoveal CNV using vitreoretinal surgical techniques. The anatomical and
functional results of surgery were analyzed. RESULTS: The median age of the
patients was 42 years (range, 16-68 years), and the median follow-up time
was 24 months (range, 6-48 months). Visual acuity improved by 2 or more
Snellen lines in 22 (35%) of the 63 eyes, was unchanged in 28 (44%) of the
eyes, and worsened in 13 (21%) of the eyes. Eleven (17%) of the 63 eyes
improved to a visual acuity of 20/50 or better. Eyes with an initial visual
acuity of 20/200 or worse had a better prognosis for improved vision (ie,
26 [41%] of the eyes) than those with an initial visual acuity of 20/100 or
better (ie, 5 [8%] of the eyes). Recurrence of the subfoveal CNV occurred
in 24 (38%) of the 63 eyes and was more common in those eyes that received
preoperative laser photocoagulation (ie, 15 [47%] of the eyes). The median
time to recurrence was 5 months after surgery. Post-operative complications
included macular striae in 4 (6%) of the 63 eyes, rhegmatogenous retinal
detachment in 2 (3%) of the eyes, retinal tear in 1 (1.6%) of the eyes, and
progression of cataract in 19 (30%) of the eyes. CONCLUSIONS: Surgical
excision of subfoveal CNV may be an effective therapeutic modality in
patients with the presumed ocular histoplasmosis syndrome that offers the
possibility of improving central vision in many patients. Factors possibly
associated with a favorable visual prognosis include younger patient age
and the absence of previous laser photocoagulation.
