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Standard weakening procedures may not harm macula
J AAPOS. 2011;15(4):334-337.
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Three-dimensional optical coherence tomography showed no adverse effects on the macula resulting from manipulation of the inferior oblique muscle during standard weakening procedures, a study found.
"During weakening procedures of the inferior oblique muscle, isolation and hooking of the muscle result in some traction on the muscle insertion. The muscle is inserted over a critical area of the eye, nearly overlying the macula," the study authors said.
The prospective study included 23 eyes of 16 patients that underwent surgery for correction of horizontal strabismus and weakening of the inferior oblique muscle overaction. Mean patient age was 5.2 years (range: 3 years to 15 years).
Patients with preoperative retinal or macular pathology, neurological disease, orbital pathology, craniofacial anomalies, sensory strabismus, restrictive strabismus, or intolerance of OCT scanning were excluded.
The Topcon 3D OCT-1000 Mark II was used to obtain three-dimensional images of the macula before surgery and 1 day, 1 week and 1 month postoperatively.
All patients also underwent assessments of uncorrected visual acuity, cycloplegic refraction, anterior segment status and dilated fundus examinations.
Study results showed satisfactory correction of ocular deviation and elimination of inferior oblique muscle overaction and no major complications such as fat prolapse, ocular hemorrhage or scleral perforation during or after surgery. Data also showed no refractive changes and no changes in corrected or uncorrected visual acuity.
OCT scans showed no morphologic changes, postoperative hyperreflectivity, lesions, hyporeflective lesions or shadow areas. Preoperative and postoperative retinal thickness measurements were comparable, the authors said.
The study by Kasem and Sabry answers an interesting question that has been brought up by some strabismus surgeons in the past. This novel study idea utilizing OCT following common surgical procedures that are performed on the inferior oblique appears to answer the question about whether inferior oblique surgery can affect the macula. Their reported results should allow strabismus surgeons to perform uncomplicated inferior oblique surgery without the fear of vision loss due to subtle macular changes.
– Scott E. Olitsky, MD
OSN
Pediatrics/Strabismus Board Member
Disclosure: Dr. Olitsky has no relevant
financial disclosures.