Macular rotation with and without counter-rotation of the globe in patients with age-related macular degeneration

Background: Macular rotation to treat exudative age-related macular degener ation (AMD) involves translocation of the fovea to a site with intact retin al pigment epithelium. To avoid the inevitable postoperative cyclotropia we combined this procedure with torsional muscle surgery. Patients and method s: In 30 eyes the macula was rotated upward by 30-50 degrees following comp lete artificial retinal detachment and a 360 degrees retinotomy. Simultaneo us torsional muscle surgery was not carried out in the first 8 eyes; in the remaining 22 eyes surgery of the oblique muscles was performed alone or in combination with surgery of two or four rectus muscles. Simultaneously or later, muscle surgery was performed on the fellow eye in 17 of these patien ts. Three of the eight patients who had no primary muscle surgery were oper ated on later. They had muscle surgery on the macular-rotated eye and on th e fellow eye. Results: Postoperatively, the silicone oil was removed from a ll but one eye and an intraocular lens implanted in all but two eyes. Five eyes developed a postoperative retinal detachment, three of them with proli ferative vitreoretinopathy. Three other eyes developed a recurrence of the choroidal neovascularization. At last examination, 18 of the 30 eyes (60%) had a near vision of 0.4 or better, sufficient for the reading of normal ne wsprint. Six of the eight patients who did not undergo muscle surgery repor ted considerable disorientation caused by the postoperative diplopia and cy clotropia. The muscle operation, which has been performed in a total of 25 patients, conferred complete freedom from complaints in all but one patient . Conclusion: Macular rotation succeeded in restoring reading vision in abo ut half of cases of exudative AMD, at least in the short term. The most ser ious complication was the development of a retinal detachment. The extremel y disorienting side effects of diplopia and tilted image could be prevented or effectively treated by muscle surgery for counter-rotation of the globe , if need be also in the fellow eye.