Background:
From 1997 to 2003, the Submacular Surgery Trials (SST) were conducted to evaluate the role of surgical removal of subfoveal choroidal neovascular lesions in the treatment of patients with advanced wet macular degeneration. When choroidal neovascularization develops in a subfoveal location, the effect on central vision may be devastating. Therefore surgical removal of choroidal neovascularization and associated tissue from the eye, in theory, has the potential to improve the central vision.

Two trials were conducted for subfoveal choroidal neovascularization. In one trial (SST Group N Trial) patients had macular degeneration related CNV & less blood in the macula and somewhat better vision (20/100 to 20/800). In the other trial (SST Group B Trial) patients had large amount of blood in the macula and poor vision (20/100 to light perception).
A successful outcome was defined as either improvement of vision or vision loss of no more than 1 line at the 24-month examination.

Submacular surgery, as performed in this clinical trial, did not improve or preserve VA for 24 months in more eyes than observation and therefore is not recommended for patients with similar lesions.

More on the 454 patients with AMD-related CNV (SST-N)

• Patients were 50 years or older; median age of 77.
• Each patient had a subfoveal neovascular lesion. The surgeons classified the lesions as 'classic' choroidal neovascularization--a pattern seen on photographs of the back of the eye taken as the new blood vessels fill with fluorescein dye.
• Prospective patients with prior treatment for CNV were ineligible.
• All patients, surgery and observation alike, were given follow-up examinations at 3-, 6-, 12-, and 24-month periods after enrollment. Adverse effects were reported immediately following an examination. A separate Adverse Event Review Committee classified such events.
• Rhegmatogenous retinal detachment occurred in twelve surgery eyes and one observation eye.
• Of the surgery patients with no previous cataract surgery, 39 percent received cataract surgery by the 24-month examination, compared with five percent of the observation patients.

More on the 336 patients with more extensive bleeding from AMD (SST-B)

• Patients were 50 years or older with a median age of 79.
• Eligible patients had lesions of 8.9 mm or larger, at least half of which was blood under the center of the macula. They also had best-corrected vision of 20/100 to light perception in the study eye.
• Patients with previous eye treatments with laser photocoagulation were permitted in the trial.
• Two years after surgery, 44 percent of surgery eyes with no prior cataract surgery needed cataract surgery.
• Rhegmatogenous retinal detachment developed in 27 surgery eyes compared with only three of the observed eyes. The SST leadership called this a relatively high level of risk that increased in patients with larger lesions and worse visual acuity levels."

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