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. 1995 May;79(5):417–423. doi: 10.1136/bjo.79.5.417

Relation of the functional and structural fundus changes after submacular surgery for neovascular age-related macular degeneration.

H L Hudson 1, D A Frambach 1, P F Lopez 1
PMCID: PMC505127  PMID: 7612551

Abstract

AIMS--This study was carried out to investigate the precise pattern of visual loss associated with subfoveal choroidal neovascular membranes and the mechanism by which vision is stabilised or improved after submacular surgery. METHODS--Preoperative and postoperative quantitative microperimetry using the scanning laser ophthalmoscope was performed on six eyes of five patients with age-related macular degeneration who underwent subfoveal choroidal neovascular membrane excision. The relation of the microperimetry findings to the preoperative and postoperative fluorescein angiographic features was also assessed. RESULTS--Four of the six eyes had visual improvement by the 6 month postoperative visit; the other two had stabilisation of vision at the preoperative level. Despite these beneficial visual effects, none of the patients fixated within the bed of the excised choroidal neovascular membrane. Subfoveal choroidal membrane excision was associated with a 36% average increase in the absolute scotoma at the 1 month postoperative visit, compared with the preoperative size. The postoperative scotoma appeared to remain stable or decreased slightly in size between the 6 month and 1 year postoperative visits. Recovery of vision was associated with the development of a more stable preferred eccentric fixation locus, of which the distance from the centre of the foveal avascular zone was related to final postoperative vision. Most of the eccentric fixation loci were inferotemporal to the bed of the excised choroidal neovascular membrane. The surgical retinotomy site was associated with persistent postoperative relative scotoma in five of the six cases, but resolved in one patient after 1 year. CONCLUSION--These findings indicate that quantitative scanning laser ophthalmoscope microperimetry may aid in the surgical planning of subfoveal choroidal neovascular membrane excision.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Acosta F., Lashkari K., Reynaud X., Jalkh A. E., Van de Velde F., Chedid N. Characterization of functional changes in macular holes and cysts. Ophthalmology. 1991 Dec;98(12):1820–1823. doi: 10.1016/s0161-6420(91)32044-x. [DOI] [PubMed] [Google Scholar]
  2. Berger A. S., Kaplan H. J. Clinical experience with the surgical removal of subfoveal neovascular membranes. Short-term postoperative results. Ophthalmology. 1992 Jun;99(6):969–976. doi: 10.1016/s0161-6420(92)31869-x. [DOI] [PubMed] [Google Scholar]
  3. Faktorovich E. G., Steinberg R. H., Yasumura D., Matthes M. T., LaVail M. M. Photoreceptor degeneration in inherited retinal dystrophy delayed by basic fibroblast growth factor. Nature. 1990 Sep 6;347(6288):83–86. doi: 10.1038/347083a0. [DOI] [PubMed] [Google Scholar]
  4. Ferris F. L., 3rd, Fine S. L., Hyman L. Age-related macular degeneration and blindness due to neovascular maculopathy. Arch Ophthalmol. 1984 Nov;102(11):1640–1642. doi: 10.1001/archopht.1984.01040031330019. [DOI] [PubMed] [Google Scholar]
  5. Foulds W. S. Factors influencing visual recovery in retinal detachment surgery. Trans Ophthalmol Soc U K. 1980 Apr;100(Pt 1):72–77. [PubMed] [Google Scholar]
  6. Green W. R., Enger C. Age-related macular degeneration histopathologic studies. The 1992 Lorenz E. Zimmerman Lecture. Ophthalmology. 1993 Oct;100(10):1519–1535. doi: 10.1016/s0161-6420(93)31466-1. [DOI] [PubMed] [Google Scholar]
  7. Grossniklaus H. E., Martinez J. A., Brown V. B., Lambert H. M., Sternberg P., Jr, Capone A., Jr, Aaberg T. M., Lopez P. F. Immunohistochemical and histochemical properties of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol. 1992 Oct 15;114(4):464–472. doi: 10.1016/s0002-9394(14)71859-8. [DOI] [PubMed] [Google Scholar]
  8. Guez J. E., Le Gargasson J. F., Rigaudiere F., O'Regan J. K. Is there a systematic location for the pseudo-fovea in patients with central scotoma? Vision Res. 1993 Jun;33(9):1271–1279. doi: 10.1016/0042-6989(93)90213-g. [DOI] [PubMed] [Google Scholar]
  9. Henkind P., Gartner S. The relationship between retinal pigment epithelium and the choriocapillaris. Trans Ophthalmol Soc U K. 1983;103(Pt 4):444–447. [PubMed] [Google Scholar]
  10. Janknecht P., Soriano J. M., Funk J., Hansen L. L. Automatische Perimetrie des zentralen Gesichtsfeldes bei Erkrankungen der Makula. Klin Monbl Augenheilkd. 1991 Oct;199(4):259–263. doi: 10.1055/s-2008-1046079. [DOI] [PubMed] [Google Scholar]
  11. Jonas J. B., Gusek G. C., Naumann G. O. Optic disc, cup and neuroretinal rim size, configuration and correlations in normal eyes. Invest Ophthalmol Vis Sci. 1988 Jul;29(7):1151–1158. [PubMed] [Google Scholar]
  12. Kelley J. S. Funduscopically controlled scotometry. Trans Am Ophthalmol Soc. 1983;81:592–629. [PMC free article] [PubMed] [Google Scholar]
  13. Klein R., Davis M. D., Magli Y. L., Segal P., Klein B. E., Hubbard L. The Wisconsin age-related maculopathy grading system. Ophthalmology. 1991 Jul;98(7):1128–1134. doi: 10.1016/s0161-6420(91)32186-9. [DOI] [PubMed] [Google Scholar]
  14. LaVail M. M., Unoki K., Yasumura D., Matthes M. T., Yancopoulos G. D., Steinberg R. H. Multiple growth factors, cytokines, and neurotrophins rescue photoreceptors from the damaging effects of constant light. Proc Natl Acad Sci U S A. 1992 Dec 1;89(23):11249–11253. doi: 10.1073/pnas.89.23.11249. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Lambert H. M., Capone A., Jr, Aaberg T. M., Sternberg P., Jr, Mandell B. A., Lopez P. F. Surgical excision of subfoveal neovascular membranes in age-related macular degeneration. Am J Ophthalmol. 1992 Mar 15;113(3):257–262. doi: 10.1016/s0002-9394(14)71576-4. [DOI] [PubMed] [Google Scholar]
  16. Leibowitz H. M., Krueger D. E., Maunder L. R., Milton R. C., Kini M. M., Kahn H. A., Nickerson R. J., Pool J., Colton T. L., Ganley J. P. The Framingham Eye Study monograph: An ophthalmological and epidemiological study of cataract, glaucoma, diabetic retinopathy, macular degeneration, and visual acuity in a general population of 2631 adults, 1973-1975. Surv Ophthalmol. 1980 May-Jun;24(Suppl):335–610. [PubMed] [Google Scholar]
  17. Lopez P. F., Grossniklaus H. E., Lambert H. M., Aaberg T. M., Capone A., Jr, Sternberg P., Jr, L'Hernault N. Pathologic features of surgically excised subretinal neovascular membranes in age-related macular degeneration. Am J Ophthalmol. 1991 Dec 15;112(6):647–656. doi: 10.1016/s0002-9394(14)77270-8. [DOI] [PubMed] [Google Scholar]
  18. Lopez P. F., Lambert H. M., Grossniklaus H. E., Sternberg P., Jr Well-defined subfoveal choroidal neovascular membranes in age-related macular degeneration. Ophthalmology. 1993 Mar;100(3):415–422. doi: 10.1016/s0161-6420(93)31657-x. [DOI] [PubMed] [Google Scholar]
  19. Saxe S. J., Grossniklaus H. E., Lopez P. F., Lambert H. M., Sternberg P., Jr, L'Hernault N. Ultrastructural features of surgically excised subretinal neovascular membranes in the ocular histoplasmosis syndrome. Arch Ophthalmol. 1993 Jan;111(1):88–95. doi: 10.1001/archopht.1993.01090010092033. [DOI] [PubMed] [Google Scholar]
  20. Schuchard R. A. Validity and interpretation of Amsler grid reports. Arch Ophthalmol. 1993 Jun;111(6):776–780. doi: 10.1001/archopht.1993.01090060064024. [DOI] [PubMed] [Google Scholar]
  21. Sjaarda R. N., Frank D. A., Glaser B. M., Thompson J. T., Murphy R. P. Assessment of vision in idiopathic macular holes with macular microperimetry using the scanning laser ophthalmoscope. Ophthalmology. 1993 Oct;100(10):1513–1518. doi: 10.1016/s0161-6420(93)31448-x. [DOI] [PubMed] [Google Scholar]
  22. Sjaarda R. N., Frank D. A., Glaser B. M., Thompson J. T., Murphy R. P. Resolution of an absolute scotoma and improvement of relative scotomata after successful macular hole surgery. Am J Ophthalmol. 1993 Aug 15;116(2):129–139. doi: 10.1016/s0002-9394(14)71276-0. [DOI] [PubMed] [Google Scholar]
  23. Thomas M. A., Grand M. G., Williams D. F., Lee C. M., Pesin S. R., Lowe M. A. Surgical management of subfoveal choroidal neovascularization. Ophthalmology. 1992 Jun;99(6):952–976. doi: 10.1016/s0161-6420(92)31888-3. [DOI] [PubMed] [Google Scholar]
  24. Timberlake G. T., Mainster M. A., Peli E., Augliere R. A., Essock E. A., Arend L. E. Reading with a macular scotoma. I. Retinal location of scotoma and fixation area. Invest Ophthalmol Vis Sci. 1986 Jul;27(7):1137–1147. [PubMed] [Google Scholar]
  25. Timberlake G. T., Mainster M. A., Webb R. H., Hughes G. W., Trempe C. L. Retinal localization of scotomata by scanning laser ophthalmoscopy. Invest Ophthalmol Vis Sci. 1982 Jan;22(1):91–97. [PubMed] [Google Scholar]
  26. Weiter J. J., Wing G. L., Trempe C. L., Mainster M. A. Visual acuity related to retinal distance from the fovea in macular disease. Ann Ophthalmol. 1984 Feb;16(2):174–176. [PubMed] [Google Scholar]

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