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Amber A. Dobler-Dixon, MD; Louis B. Cantor, MD; Naval Sondhi, MD; W. Steve Ku, MD; Joni Hoop, COA

Arch Ophthalmol. 1999;117:1155-1160.

Objective  To determine the incidence and type of extraocular motility disturbance after double-plate Molteno implantation.

Methods  In a prospective clinical series, we evaluated preoperative and postoperative ocular motility at 3 and 6 months in 24 eyes of 24 patients undergoing double-plate Molteno implantation. Visual acuity, motility testing, and subjective and objective diplopia were evaluated at each examination.

Results  Within the first 6 months postoperatively, new or worse strabismus developed in 11 (46%) of the 24 study patients. Three of the 11 patients had a generalized restriction of the superior rectus and the superior oblique muscles, all of which persisted 6 months after surgery. Four patients had clinical features consistent with an acquired Brown syndrome, and 6 months after surgery, 3 of the 4 patients had a residual deviation, although the deviation in 1 patient resolved. A superior oblique palsy developed in 3 patients, and a lateral rectus palsy developed in 1 patient. All 4 of the muscle palsies resolved or were resolving during the follow-up period, which ranged from 6 to 12 months.

Conclusions  Extraocular motility disturbances are not rare after double-plate Molteno surgery. Muscle palsies, acquired Brown syndromes, and generalized restrictions occurred in similar proportions.

Clinical Relevance  Patients should be counseled before Molteno surgery concerning the risk of strabismus and diplopia.

From the Department of Ophthalmology, Indiana University School of Medicine, Indianapolis. Dr Dobler-Dixon is now in private practice in Borger, Tex, and Dr Ku is now in private practice in Plano, Tex.

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