Delayed atrophy of the retinal pigment epithelium after submacular surgery.
OBJECTIVE
We report a case of delayed atrophy of the retinal pigment epithelium (RPE) eighteen months after apparently successful excision of submacular choroidal new vessels (CNV) in a patient with age-related macular degeneration (AMD).


METHODS
Case report.


RESULTS
Submacular surgery for CNV was achieved without visible disturbance of the underlying RPE in an 83 year old man diagnosed with AMD. At the time of surgery the CNV displayed clinical features consistent with lying internal to Bruch's membrane (Type 2 configuration). There was no visible RPE defect at the fovea and vision improved during the subsequent 12 months follow-up. Eighteen months later, however, an atrophic central RPE defect appeared, with a similar shape to the CNV originally excised.


CONCLUSIONS
This case demonstrates that submacular CNV with Type 2 configuration can occur in AMD and lead to an initially favourable outcome following submacular surgery. Atrophy of the RPE nevertheless did eventually occur and in a pattern consistent with damage during the original operation. It is important to consider results of longer term follow-up when interpreting success rates for surgery in AMD.
MacLaren
R E
RE
Moorfields Eye Hospital, London - UK. maclaren@herald.ox.ac.uk
Aylward
G W
GW
D000368:Aged; D000369:Aged, 80 and over; D001284:Atrophy; D016570:Bruch Membrane / Q000601:surgery; D020256:Choroidal Neovascularization / Q000601:surgery*; D005451:Fluorescein Angiography; D006801:Humans; D008266:Macula Lutea / Q000601:surgery*; D008268:Macular Degeneration / Q000601:surgery*; D008297:Male; D010857:Pigment Epithelium of Eye / Q000473:pathology*; D011183:Postoperative Complications; D041623:Tomography, Optical Coherence