Combined superior oblique muscle recession and inferior oblique muscle advancement and transposition for cyclotorsion associated with macular translocation surgery.

PURPOSE: The purpose of this study was to evaluate the effects of oblique muscle surgery on the large-angle incyclotorsion resulting from macular translocation surgery for severe age-related macular degeneration. METHODS: Patients undergoing macular translocation (superiorly) at our institution from May 1996 until November 1998 were included. In the Staged Group, strabismus surgery for symptomatic incyclotorsion was performed after the macular translocation, and in the Combined Group, it was performed simultaneous with the macular translocation. Cyclotorsion was quantified using Maddox rod testing. Surgery for incyclotorsion included superior oblique muscle recession combined with inferior oblique muscle advancement and transposition in the affected eyes. The minimum follow-up time was 6 weeks. RESULTS: Fifteen patients (15 eyes) were included (ages 66-89 years). Nine eyes (Baseline Group) had macular translocation surgery before any strabismus surgery; the mean postoperative incylotorsional angle was 33.4 +/- 18.3 degrees (range, 20-80 degrees) after a mean follow-up of 6.6 months. Four of these eyes (Staged Group) underwent oblique muscle surgery for symptomatic incyclotorsion, which reduced the mean incyclotorsion from 26.9 +/- 6.9 degrees (range, 20-35 degrees) to 9. 9 +/- 7.9 degrees (range, 2.5-20 degrees)-a mean reduction of 16.9 +/- 1.3 degrees (P =.00012), after a mean follow-up of 4.6 months. Six additional eyes (Combined Group) had simultaneous macular translocation and oblique muscle surgery, with a mean postoperative cyclotorsional angle of 14.0 +/- 6.7 degrees (range, 4-22.5 degrees), after a mean follow-up of 3.75 months. CONCLUSION: Oblique muscle surgery is effective at reducing the large degree of incyclotorsion resulting from macular translocation surgery and may be used either following or simultaneous with retinal surgery.