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Surgical Treatment of Incyclotorsion After Macular Translocation

Correspondence: Requests for reprints should be addressed to: Dr. Edward G. Buckley, Duke University Eye Center, P.O. Box 3802, Durham, NC 27710

Introduction: The purpose of this study was to review the incidence and management of strabismus after macular translocation surgery for severe agerelated macular degeneration.

Methods: Patients undergoing macular translocation surgery at our institution from May 1996 to March 2000 were included. Macular translocation surgery consisted either of limited outfolding, limited infolding, or 360-degree retinotomy. Cyclotorsion was quantified using Maddox rod testing. Surgery for incyclotorsion included superior oblique muscle recession and inferior oblique muscle advancement. For incyclotorsion greater than 20°, additional surgery consisting of either horizontal or vertical rectus muscle offset was performed.

Results: Of the 36 patients who had either limited outfolding or limited infolding, only three (11%) developed strabismus. In patients undergoing 360- degree retinotomy, 22 of 26 patients (84%) acquired strabismus. Oblique muscle surgery alone for incyclotorsion was performed on 15 patients and was effective in reducing torsion by 17°. Six patients had oblique surgery plus horizontal rectus muscle offsets, which reduced incyclotorsion an average of 30°.

Conclusion: Oblique muscle surgery alone, or in combination with horizontal rectus muscle offset, is effective in reducing the large degree of incyclotorsion which can result from macular translocation surgery. Limited macular translocation surgery produces significantly less postoperative strabismus.

Key words: torsion, age-related macular degeneration, surgery