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Strabological Findings after Macular Translocation Surgery with 360° Retinotomy

¹From the Department of Ophthalmology, Hamamatsu University School of Medicine, Hamamatsu, Japan; the ²Department of Ophthalmology, Nagoya University School of Medicine, Nagoya, Japan; and the ³Department of Ophthalmology, Kamiiida Daiichi General Hospital, Nagoya, Japan.

PURPOSE. To examine the strabological findings after macular translocation surgery with a 360° retinotomy.

METHODS. Thirty-two patients who underwent macular translocation surgery were divided into three groups based on their responses to the Bagolini striated lenses test: fusion, ignoring the image, and diplopia. The relevant factors affecting binocularity were compared among the three groups.

RESULTS. Five patients had peripheral fusion and three of these had gross stereopsis. Fifteen patients ignored the second image, and 12 patients had diplopia. The objective angle of macular rotation was smaller in the patients with peripheral fusion (15.0 ± 6.1°) than in those with diplopia (32.7 ± 11.7°). The subjective angle of cyclotorsion in those with peripheral fusion (6.0 ± 4.2°) was smaller than in those who ignored the image ("ignoring" group; 20.5 ± 9.19°) and the diplopia group (30.7 ± 12.8°). The amount of torsional sensory compensation in patients with diplopia (2.08 ± 3.83°) was significantly smaller than in those with peripheral fusion (9.00 ± 7.42°) and in the ignoring group (6.73 ± 3.86°). Patients with peripheral fusion were significantly younger (54.2 ± 14.3 years) than those in the ignoring group (67.7 ± 10.0 years) and those with diplopia (68.0 ± 5.4 years).

CONCLUSIONS. Adaptive mechanisms are activated to reduce the surgically induced objective angle of cyclotorsion, and a cyclodeviation of 15° was the critical angle separating those who had peripheral fusion from those who did not. This value corresponds to the cyclofusional amplitude in normal adults.