Visual function after foveal translocation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy

PURPOSE: To assess functional and anatomical outcomes after foveal transloc ation with 360-degree retinotomy and simultaneous torsional muscle surgery in patients with myopic neovascular maculopathy. METHODS: Foveal translocation with 360-degree retinotomy was performed in 1 1 eyes of 11 patients with myopic neovascular maculopathy. Ten eyes had sim ultaneous torsional muscle surgery with recession of the superior oblique m uscle and tucking of the inferior oblique muscle. Silicone oil removal with or without intraocular lens implantation was performed 2 to 8 weeks after the primary procedure. Visual acuity, binocular function, and degree of cyc lotorsion were assessed preoperatively and postoperatively. Angles of retin al and globe rotation, distance of foveal shift, and surgical complications were also investigated. RESULTS: With a mean postoperative follow-up of 6.2 months (range, 3 to 13 months), vision improved (greater than 0.2 logarithm of minimal angle of re solution [logMAR] units) in eight eyes, was unchanged in two eyes, and wors ened (greater than 0,2 logMAR units) in 1 eye. Seven of 11 eyes (64%) had a final visual acuity of 20/50 or better. Five patients developed or maintai ned binocular fusion, four patients continued to have suppression, and two patients developed diplopia that was managed by spectacles with Fresnel pri sms. Subjective cyclotorsion was less than 8 degrees in 10 eyes. Mean retin al and globe rotations were 23.4 degrees and 19.8 degrees, respectively. Av erage size of the choroidal neovascular membrane was 0.8 disk diameter, whe reas the average distance of foveal shift was 1.5 disk diameter. After the primary procedure, three eyes developed retinal detachment, one eye macular hole, and one eye proliferative vitreoretinopathy. These complications wer e successfully managed by additional surgery. CONCLUSION: Foveal translocation with 360-degree retinotomy is effective in restoring vision in some patients with myopic neovascular maculopathy. Alt hough the development of torsional diplopia is generally obviated by simult aneous extraocular muscle surgery, a relatively high incidence of surgical complications should be taken into account with this procedure. (Am J Ophth almol 2001;131:101-110, (C) 2001 by Elsevier Science Inc. All rights reserv ed.).