97th DOG Annual Meeting 1999

V8

TORSIONAL MUSCLE SURGERY IN MACULAR ROTATION

U. Eckardt, C. Eckardt

Translocation of the fovea in macular rotation surgery can lead to diplopia and tilted image. In an attempt to eliminate these phenomena, we performed various procedures on the oblique and rectus eye muscles at different times.

Materials and Methods: Between February 1997 and February 1999 43 patients were treated for age related macular degeneration by a retina rotation of 20-45º upward. In all cases the macular-rotated eye was treated with a combined surgery on the oblique muscles. In addition, by splitting of rectus muscles 2 to 4 muscles strips were created in the majority of cases. These mucles strips were transposed in such a way that a counter-rotation was created (7-8° per muscle strip) . In 33 patients this procedure was done as a primary procedure, i.e. simultaneously with the retina rotation. In the other patients it was done secondary performed either in combination with the silicone oil removal (mean: 6 weeks after macular rotation) (n = 5) or at a later time (n = 5). In 35 patients additional primary or secondary muscle surgery of the fellow eye was carried out for teatment of vertical and horizontal deviations and remaining cyclotropias.

Results: A single operation on the oblique eye muscles achieved a counter-rotation (excyclotropia) of 12-15º which was usually not sufficient. Additional muscle strip surgery on the rectus muscles, however, led to a complete compensation of the disturbing incyclotropia in all cases. The final outcome was not dependend on the time of muscle surgery. Eyes that had undergone primary muscle surgery had the same number of reoperations than those with secondary muscle surgery.

Conclusions: Counterrotation of the globe by means of torsional muscle surgery enables the compensation of retina rotations of up to 45º. However, complete elimination of the diplopia and tilted image often requires additional surgery on the fellow eye. Muscle surgery can effectively be performed as a primary procedure in order to reduce the number of operations.

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


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