Induced corneal astigmatism after macular translocation surgery with scleral infolding.
OBJECTIVE
To document the corneal astigmatism that occurs with macular translocation after scleral infolding surgery.


METHODS
Retrospective case series of a nonrandomized clinical trial.


METHODS
Eight consecutive age-related macular degeneration patients (eight eyes) with choroidal neovascularization who underwent macular translocation with scleral infolding at the Duke University Eye Center from December 1998 through October 1999.


METHODS
We retrospectively reviewed the charts of eight consecutive patients who underwent macular translocation surgery involving scleral infolding in the superotemporal quadrant. Two patients subsequently underwent release of scleral infolding.


METHODS
After surgery, these eyes were evaluated for corneal astigmatism with manifest refraction, keratometry, and computerized corneal topography.


RESULTS
All eight eyes of eight patients revealed marked degrees of corneal astigmatism. Measurement of astigmatism via manifest refraction, keratometry, and corneal topography confirmed postoperative astigmatism corresponding to the axis of the scleral infolding. The amount of corneal astigmatism ranged from 1.75 to 7.37 diopters (D; mean, 4.60 D), with steepening along the axis of scleral infolding in the superotemporal quadrant of each eye (mean, 42.50 degrees from vertical; range, 24 degrees -66 degrees from vertical). Release of scleral infolding in two patients resulted in significant reduction of corneal astigmatism.


CONCLUSIONS
Scleral shortening procedures used in macular translocation surgery may induce large amounts of corneal astigmatism. These patients should be assessed with keratometry and corneal topography to determine the accurate amount and axis. Thereafter, contact lens fitting or scleral infolding release may be considered as therapeutic options for large amounts of astigmatism persisting after surgery.
Kim
T
T
Cornea Service, Department of Ophthalmology, Duke University Medical Center, Durham, North Carolina 27710-3802, USA. terry.kim@duke.edu
Krishnasamy
S
S
Meyer
C H
CH
Toth
C A
CA
D001251:Astigmatism / Q000209:etiology* / Q000503:physiopathology; D020256:Choroidal Neovascularization / Q000601:surgery*; D003316:Corneal Diseases / Q000209:etiology* / Q000503:physiopathology; D019781:Corneal Topography; D006801:Humans; D008266:Macula Lutea / Q000637:transplantation*; D008268:Macular Degeneration / Q000601:surgery*; D011183:Postoperative Complications; D012029:Refraction, Ocular; D012189:Retrospective Studies; D012590:Sclera / Q000601:surgery*; D014182:Transplantation, Autologous / Q000009:adverse effects; D014792:Visual Acuity