97th DOG Annual Meeting 1999
MACULAR ROTATION - 2 YEARS EXPERIENCE IN THE TREATMENT OF AGE - RELATED MACULAR DEGENERATION
C. Eckardt, U. Eckardt
Between February 1997 and February 1999 we performed macular rotations on 47 patients with age-related macular degeneration. Here we report on the results.
Materials and Methods: In all patients surgery was performed on the functionally better eye which only a few days or weeks earlier had allowed unimpaired reading. Intraoperatively, retinal detachment, 360 degree retinotomy and removal of the choroidal neovascularization membrane (CNV) was followed by a 20 to 45-degree rotation of the retina upward around the optic nerve (depending on the extent of the retinal pigment epithelium [RPE] defect) and injection of silicone oil or gas. In 43 patients, muscle surgery was additionally performed to compensate for the incyclotropia caused by the retinal rotation.
Results: In 3 eyes we were unable to translocate the macula sufficiently far out of the RPE defect. In one eye the rotation produced a posterior retinal tear. Postoperatively the silicone oil could be successfully removed from all eyes (mean: 6 weeks after macular rotation). Thirty-two eyes received an anterior chamber lens, 12 eyes received a posterior chamber lens, 2 eyes were already pseudophakic. In 4 eyes a circumscribed retinal detachment occurred which was easily treated by gas tamponade, 3 eyes developed a PVR. Three eyes developed a recurrence of the CNV, 4 eyes a cystoid macular edema. At final examination 14 eyes had a far visual acuity of 0.4 or better and 25 eyes had a near visual acuity of 0.4 or better (Oculus charts). All patients who were treated with muscle surgery did not complain of diplopia or tilted vision.
Conclusions: In half of the cases macular rotation succeeded in restoring foveal function and thus the ability to read. Diplopia and cyclotropia could be prevented or effectively treated by muscle surgery.
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