Strabological results in patients with macular translocation surgery and counterrotation of the globe as a secondary procedure.

摘要

INTRODUCTION: Age-related macular degeneration is the most common cause of irreversible loss of visual acuity, including the ability to read, in elderly patients. One of the surgical treatment options is macular translocation with 360 degrees retinotomy. The orthoptic results of torsional muscle surgery as a second procedure are demonstrated. MATERIALS AND METHODS: Between January 1999 and December 2000, the macula was rotated upward by 12-45 degrees in 10 eyes following complete artificial detachment and a 360 degrees retinotomy. In these patients, torsional surgery was carried out as a second procedure. Depending on the resulting cyclotorsion, we performed surgery on the oblique muscles only in four patients with a cyclotropia of 12-20 degrees and a combination of oblique muscle surgery with surgery of two or four rectus muscles in the remaining six eyes (cyclotropia over 21 degrees ). The pre- and postoperative diagnostic techniques included visual acuity, reading vision and the orthoptic status. RESULTS: Due to the unilateral ectopia of the macula, all patients presented postoperative strabismus with a vertical deviation of 2-10 degrees and a subjective cyclotropia between 12 degrees and 40 degrees. After surgery on the oblique muscles, the patients showed a residual cyclotropia of 0-6 degrees. In patients in whom surgery on the oblique muscles was accompanied by rectus muscle surgery, the remaining cyclotorsion was 5-13 degrees. Four patients excluded the non-operated fellow eye, six patients experienced double vision under binocular conditions and thus required prescription of additional prism glasses. CONCLUSION: Macular translocation causes diplopia under binocular conditions because of the unilateral ectopia of the macular region with cyclotropia and vertical deviation. These problems can be resolved or reduced by oblique muscle surgery or in combination with additional surgery on the rectus muscles, depending on the range of the cyclotorsion. Performing the torsional surgery as a second procedure after macular rotation with an exact preoperative measurement of the subjective cyclodeviation appears to be useful.