97th DOG Annual Meeting 1999



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.

Augenklinik, Städtische Kliniken Frankfurt a-M. - Höchst, Gotenstr. 6-8, D - 65929 Frankfurt