Prospective evaluation of extraocular motility following double-plate molteno implantation

Objective: To determine the incidence and type of extraocular motility dist urbance after double-plate Molteno implantation. Methods: In a prospective clinical series, we evaluated preoperative and po stoperative ocular motility at 3 and 6 months in 24 eyes of 24 patients und ergoing double-plate Molteno implantation. Visual acuity, motility testing, and subjective and objective diplopia were evaluated at each examination. Results: Within the first 6 months postoperatively, new or worse strabismus developed in 11 (46%) of the 24 study patients. Three of the 11 patients h ad a generalized restriction of the superior rectus and the superior obliqu e muscles, all of which persisted 6 months after surgery. Four patients had clinical features consistent with an acquired Brown syndrome, and 6 months after surgery, 3 of the 4 patients had a residual deviation, although the deviation in 1 patient resolved. A superior oblique palsy developed in 3 pa tients, and a lateral rectus palsy developed in 1 patient. All 4 of the mus cle palsies resolved or were resolving during the follow-up period, which r anged from 6 to 12 months. Conclusions: Extraocular motility disturbances are not rare after double-pl ate Molteno surgery. Muscle palsies, acquired Brown syndromes, and generali zed restrictions occurred in similar proportions. Clinical Relevance: Patients should be counseled before Molteno surgery con cerning the risk of strabismus and diplopia.