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- The Editor:
Dr. Paul Finger - The Editor:
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Patient Information:
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Surgical
Removal By
Igal Leibovitch MD, Anat
Loewenstein MD Introduction: In our description of classic "wet" macular degeneration we noted that a frond or patch of abnormal blood vessels can grow beneath the macular retina. These new blood vessels are like wires with bad insulation. They can leak, break and bleed. When they leak they cause scarring of the retina and loss of central vision. A new surgical technique has been devised for removal of these abnormal "neovascular" blood vessels before they destroy vision. Methods: The current technique involves removing most of the clear gel which fills the normal eye (vitrectomy), followed by a small incision in the retina called a retinotomy. A syringe is then used to inject a liquid solution through the retinotomy and under the retina. This separates the retina from the underlying choroid layer and allows the surgeon to grasp the subretinal neovascularization. This is done using a special instrument called a retinal pick which is inserted through the retinotomy. Once the abnormal blood vessels are captured, they are pulled out from under the retina and removed from the eye. Possible complications of this technique are retinal tears, retinal detachment, intraocular bleeding, infection and cataract formation. After surgery the abnormal vessels can regrow and new subretinal neovascularization can develop. Most patients do not develop these complications. Results: Submacular surgery has been shown beneficial in several phase-I clinical studies. Improvement of vision has been reported in 20-35%, and stabilization of visual acuity in 40-52% of patients. It has not (as yet) been proven to be significantly better than observation (no treatment) by a prospective-randomized clinical trial. The Submacular Surgery Trials (SST) are ongoing randomized clinical trials designed to determine if submacular surgery stabilizes or improves vision more than observation (in selected cases of subfoveal CNV). Patients who are eligible for SST are not eligible for the photodynamic therapy (PDT). Conclusion: Submacular surgery is another approach to the treatment of the classic "wet" form of macular degeneration with subretinal neovascularization. We hope the ongoing controlled clinical trial SST will determine the role of subretinal surgery for patients with macular degeneration. References: 1.
Sears J, Capone A Jr, Aaberg T Sr, et al. Surgical management
of subfoveal neovascularization in children. Ophthalmology 1999;106:920-924.
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