A Cochrane review [Abstract] 1 included 3 studies with a total of 860 subjects. 2 studies (n=790) compared submacular surgery with observation in people affected by subfoveal neovascular age-related macular degeneration with or without extensive blood in the macula. There was no difference between macular surgery and observation regarding visual loss (RR 0.96, 95% CI 0.84 to 1.09) or visual gain (RR 1.06, 95% CI 0.75 to 1.51) of 2 or more lines at one year. The risk difference was -2% (95% CI -10% to 5%) and 1% (95% CI -4% to 6%) for visual loss and visual gain, respectively, thus excluding a large benefit with surgery also in terms of absolute risk in these patients. Cataract needing surgery (RR 8.69, 95% CI 4.06 to 18.61) and retinal detachment (RR 6.13, 95% CI 2.81 to 13.38) were more common among operated patients, and detachment occurred in 5% of patients with no extensive blood and in 18% of those with extensive blood beneath the macula.
A pilot study compared submacular surgery with laser photocoagulation (n=70). No difference between the two treatments could be demonstrated for any outcome measure, but estimates were very imprecise because of small sample size.
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