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J. Mehta, D.W. Wong, J. Wylie, J. Young; Binocular Control Following Macular Relocation Surgery for Age–Related Macular Degeneration . Invest. Ophthalmol. Vis. Sci. 2006;47(13):2168.
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Age related macular degeneration occurs in people aged over 60 and is currently the leading cause of blindness in the western world. Macular relocation surgery (MRS) with 360° retinotomy has been shown to stabilise or in some cases improve visual acuity. However, little is known regarding the binocular control of patients who have undergone MRS and counter–rotation surgery to correct the tilt. We therefore investigated the binocular control of patients with AMD 12 months after they had been treated with MRS followed by counter–rotation surgery.
We examined 32 patients pre–operatively and at a 12 month follow up visit. Retinal correspondence was assessed by bagolini glasses, stereopsis was assessed using Wirt and fixation was assessed by observing binocular convergence and cover–test. The data enabled us to group patients into one of four categories depending on the level of binocular control; Binocular single vision (‘BSV’), exclusion of the affected eye, exclusion of the fellow eye and diplopia. A patient was deemed to have ‘BSV’ if they had a positive response to Bagolini glasses and Wirt. The data was analyzed with cross–tabulation to determine where there was a change in binocular control from pre–treatment to the 12 month follow up visit.
Preoperatively, 9 patients demonstrated ‘BSV’, 5 excluded the affected eye, 18 excluded the fellow eye and no patients had diplopia. At the 12 month follow up, of the 9 patients who demonstrated ‘BSV’, 3 continued to demonstrate ‘BSV’, whilst 4 progressed to exclusion of the affected eye and 2 had diplopia. The 5 patients who excluded the affected eye pre–operatively, 3 continued to exclude that eye and 1 demonstrated ‘BSV’ and 1 excluded the fellow eye. Of the 18 who excluded the fellow eye pre–operatively, 10 patients continued to exclude that eye, 4 demonstrated ‘BSV’ and 4 went on to exclude the affected eye.
Our results concur with previous studies which show that binocular control is poor following MRS and counter–rotation surgery. Following macular rotation, retinal points have been shifted, hence producing a degree of distortion and an obstacle to superimposition of the images. However, in our sample 4 patients who had no BSV preoperatively demonstrated BSV after treatment.
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