PURPOSE: Our aim was to evaluate the frequency, duration and therapy of diplopia in primary position caused by motility disorders after retinal detachments treated only with encircling bands. METHODS: A retrospective review is made of 264 consecutive patients. RESULTS: At 6 months after surgery,18 (7%) out of the 264 patients had motility disorders with diplopia in primary position. In 55%, we found an esotropia and vertical deviation. For the treatment of diplopia, eight patients had prisms foils, five of whom are scheduled for surgery, six patients wear prism glasses and three patients did not return for follow up after their sight had been corrected with prisms. An operation for strabism was necessary in three cases, mainly because of hypertrophic scarring (adhesion syndrome), rather than suturing material or muscular decompensation. One patient needed eye occlusion for untreatable diplopia. The average change of refraction after the encircling procedure was -2.0 D. CONCLUSIONS: We recommend avoiding unnecessary preparation of the muscles when placing the encircling band (without destruction of the Tenon or periorbital tissue), motility exercises after the operation and full refractive correction for sensory compensation of deviations as early as possible. In addition, antiphlogistic drugs should be used to avoid scarring and treatment with prism lenses. Removal of the encircling band does not seem to improve the motility as the disorder is mainly caused by hypertrophic scarring, neither does mitomycin C or the application of viscoelastic substances.
PURPOSE: Our aim was to evaluate the frequency, duration and therapy of diplopia in primary position caused by motility disorders after retinal detachments treated only with encircling bands. METHODS: A retrospective review is made of 264 consecutive patients. RESULTS: At 6 months after surgery,18 (7%) out of the 264 patients had motility disorders with diplopia in primary position. In 55%, we found an esotropia and vertical deviation. For the treatment of diplopia, eight patients had prisms foils, five of whom are scheduled for surgery, six patients wear prism glasses and three patients did not return for follow up after their sight had been corrected with prisms. An operation for strabism was necessary in three cases, mainly because of hypertrophic scarring (adhesion syndrome), rather than suturing material or muscular decompensation. One patient needed eye occlusion for untreatable diplopia. The average change of refraction after the encircling procedure was -2.0 D. CONCLUSIONS: We recommend avoiding unnecessary preparation of the muscles when placing the encircling band (without destruction of the Tenon or periorbital tissue), motility exercises after the operation and full refractive correction for sensory compensation of deviations as early as possible. In addition, antiphlogistic drugs should be used to avoid scarring and treatment with prism lenses. Removal of the encircling band does not seem to improve the motility as the disorder is mainly caused by hypertrophic scarring, neither does mitomycin C or the application of viscoelastic substances.
Authors: Sei Yeul Oh; Robert A Clark; Federico Velez; Arthur L Rosenbaum; Joseph L Demer Journal: Invest Ophthalmol Vis Sci Date: 2002-07 Impact factor: 4.799