What invasive surgery for CNV treatment has been largely abandoned today?

Sub-macular surgery has been largely abandoned in the treatment of choroidal neovascularization (CNV) primarily due to its associated risks and complications, which can often outweigh the benefits. This invasive procedure involved directly accessing the sub-macular space to remove or treat CNV. Patients undergoing this surgery frequently experienced significant complications, including retinal detachment, intraocular hemorrhage, and cataract formation. Furthermore, advancements in less invasive treatments, such as anti-VEGF injections, have demonstrated greater efficacy and safety profiles. These newer therapies target the underlying mechanisms of CNV without the need for such invasive procedures, making sub-macular surgery less favored in current clinical practice.

In the context of the other options, vitrectomy is still used in certain cases, particularly when there are issues like vitreous traction or other complications that necessitate its use. Laser photocoagulation has a role in selective cases of CNV, especially in classic CNV, but its applicability has diminished with the advent of anti-VEGF therapies. Pneumatic retinopexy is a procedure primarily used for retinal detachments and is not specifically for treating CNV, highlighting the specialization of sub-macular surgery in this context.