gms | German Medical Science

Due to the risk of surgery – not due to costs – submacular surgery should be confined to indications outside intravitreal Injections.

This includes:

1.

Non-Responders to VEGF-Blockade

2.

Pigmentepithelium rupture (selected cases)

3.

Massive subretinal hemorrhage

4.

Geographic Atrophy (early stage)

In my opinion a non-responder should be characterized as an eye under VEGF-blockage that looses at least 5 letters, in conjunction with a fresh choroidal neovascularisation. The leakage may persist or may be followed by submacular fibrosis. RPE-ruptues or massive submacular hemorrhages may imitate a non-responder. In general the non-responder is being identified rather late, rendering alternative (surgical) interventions ineffective.

An RPE-rupture leaving the fovea unsupported leaves no other choice than pigment cell translocation and may at best allow visual improvement.

Massive submacular hemorrhage is a likely indication to surgery, when displacement by a gas bubble is considered as impossible.

Geographic atrophy may be an indication to surgery, when it is progressiv, and when there is useful remaining vision (central fixation). In this case stabilisation of central vision would mean a prognostic improvement to the patient.