Sub-macular surgery: is still an option for age-related macular degeneration?

PURPOSE: This review summarizes the data reported in peer-reviewed literature on the effects of submacular surgery for age-related macular degeneration (AMD) associated with choriodal neovascularization (CNV).

METHODS: A review of the MEDLINE database has been performed in order to examine the therapeutic effects of submacular surgical treatments in patients affected by AMD.

RESULTS: The multicenter studies conducted by the Submacular Surgery Trials Research Group compare the removal of the CNV complex, both with (336) and without blood (454), with observation in patients affected by AMD. At a 1-year follow-up, no benefit in preventing visual loss had been shown. Furthermore, complications occurred in the surgery arm such as retinal detachment and lens opacification. No differences have been found between submacular surgery and laser photocoagulation in terms of visual acuity and quality of life. As yet, there are no randomized controlled trials concerning retinal pigment epithelium and choroid translocation or macular translocation, but only prospective, non-controlled case series with low quality of evidence.

CONCLUSIONS: No evidence of potential benefit from submacular removal of the CNV complex due to AMD has been shown. Randomized clinical trails (RCT) concerning other submacular surgical approaches are not available. There are sufficient non-comparative data on retinal pigment epithelium (RPE) graft to warrant an RCT especially in patients with large subretinal haemorrhages, RPE rip or in Anti-VEGF non-responders.