Effect of simultaneous oblique muscle surgery in foveal translocation by 360° retinotomy

Abstract.

Purpose: To assess the effect of simultaneous oblique muscle surgery during foveal translocation surgery with 360° retinotomy in patients with neovascular maculopathy. Methods: Foveal translocation with 360° retinotomy was performed on 31 eyes of 31 patients with neovascular maculopathy (21 with age-related macular degeneration 9 with myopic neovascular maculopathy, and 1 with idiopathic neovascular maculopathy). All eyes had simultaneous torsional muscle surgery with recession of the superior oblique muscle and tucking of the inferior oblique muscle. Visual acuity, binocular vision, and degree of cyclotorsion were assessed pre- and postoperatively. The angles of retinal and global rotation, distance of foveal shift, and surgical complications were also investigated. Results: With a mean postoperative follow-up of 10.0 months, vision improved (>0.2 log MAR units) in 13 eyes, was unchanged in 9 eyes, and worsened (>0.2 log MAR units) in 9 eyes. Ten of 31 eyes (32%) had a final visual acuity of 20/50 or better. Eleven patients had binocular fusion, 13 patients showed suppression, and 7 patients developed diplopia that was managed by spectacles with prisms or by secondary muscle surgery. The mean retinal and global rotations were 30.3° and 23.7°, respectively. The average size of the choroidal neovascular membrane was 1.3 disc diameters (DD), while the average shift of the fovea was 1.5 DD. After the primary surgery, six eyes developed retinal detachment, two eyes macular hole, and three eyes proliferative vitreoretinopathy. These complications were successfully managed by additional surgery. Conclusion: Foveal translocation with 360° retinotomy is effective in restoring vision in 40% of patients with neovascular maculopathy. Simultaneous oblique muscle surgery was effective in rotating the globe by about 20°, corresponding to to a foveal shift of 1.5 DD. While the development of torsional diplopia is generally prevented by simultaneous oblique muscle surgery, the relatively high incidence of surgical complications with this procedure should be taken into account.