Extraocular Muscle Surgery for Extorsion after Macular Translocation Surgery: New Surgical Technique and Clinical Management
Presented in part as a poster at: American Academy of Ophthalmology Annual Meeting, October, 2004; New Orleans, Louisiana.
Received 11 February 2005; accepted 15 September 2005. published online 11 November 2005.
Purpose
To report a new extraocular muscle surgery procedure for large-angle extorsion, and clinical management of subjective tilt and diplopia after full macular translocation (MT360).
Design
Consecutive retrospective case series.
Participants
Seven patients with downward MT360 were evaluated after MT360, both before (preoperative) and after (postoperative) extraocular muscle surgery, with at least 6 months’ follow-up.
Methods
Information gathered included demographics, visual acuity, ocular motility, torsion by Maddox rod, ocular history, and symptoms of visual disturbance. Surgery on extraocular muscles was performed based on the magnitude of torsion measured after MT360 surgery.
Main Outcomes Measures
Maddox rod testing of torsion after MT360, and both preoperative and postoperative extraocular muscle surgery.
Results
Mean preoperative torsion was reduced from 45.4±11.3° to 8.3±4.8° (at 6 months after MT360) (P = 0.03). Extraocular muscle surgery slightly reduced the mean hypertropia of the operated eye (preoperative, 20±10 prism diopters [PD], vs. postoperative, 11±6 PD) (P = 0.06). Mean exotropia was affected minimally by extraocular muscle surgery (preoperative, 22±31 PD, vs. postoperative, 20±24 PD). Three patients required a second extraocular muscle surgery (performed on the fellow eye) to correct residual extorsion and diplopia. Overall, 85% (6/7) of patients were free of both diplopia and tilt after 1 or 2 extraocular muscle surgeries.
Conclusions
Although our patients continued to have significant horizontal/vertical strabismus postoperatively, the extraocular muscle surgery performed was successful in reducing the torsional misalignment enough such that the remaining diplopia could be successfully ignored or suppressed.
Duke University Eye Center, Durham, North Carolina.
Correspondence to Sharon F. Freedman, MD, Duke University Eye Center, Box 3802, Durham, NC 27710.
Manuscript no. 2005-134.
Grant support: Research to Prevent Blindness, New York, New York (unrestricted grant); D. Euan and Angelica H. Baird, New York, New York; and Lions Club International, Danville, Virginia.
ABSTRACT