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J AAPOS. 1998 Oct;2(5):285-92.

Ocular motility disturbances after surgery for retinal detachment.

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Moorfields Eye Hospital, London, United Kingdom.



Relatively little has been published on the management of motility problems after surgery for retinal detachment. We report a large series with the aim of describing clinical features, management, and outcome.


The charts of 68 of 86 consecutive patients referred to one of us between 1989 and 1995 were retrieved and analyzed. Sixty-two had unilateral and 6 bilateral surgery for retinal detachment. In 45 cases the macula was detached at surgery. The visual acuity of the affected eyes ranged from hand motions to 6/6. Sensory testing suggested potential binocular function in 39.7%. Fifty-nine patients had combined vertical and horizontal strabismus, 8 horizontal alone, and 1 vertical only. The average vertical deviation measured 10.2 PD and the average horizontal 19 PD.


Twelve patients underwent strabismus surgery, 26 were treated with botulinum toxin, 21 were managed conservatively with prisms or occlusion, and 8 refused or did not require treatment. Forty-seven percent of the group regained binocularity (20.5% cured with surgery or botulinum toxin, 26.5% controlled with prisms or intermittent injection with botulinum toxin). A total of 20.7% gained improvement in appearance, 19.1% were managed with permanent occlusion, and 13.2% either refused or did not require treatment.


Macula off retinal detachment, poor visual acuity plus or minus distortion, and multiple procedures for retinal reattachment are associated with a poor prognosis for restoration of binocular vision and a good outcome. In our hands, botulinum toxin treatment is the method of choice, with surgery used in selected cases.

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