ORTHOPTIC PROBLEMS OF MACULAR ROTATION WI TH AND WITHOUT MUSCLE SURGERY

Background In spite of new therapeutic approaches the treatment of age related macular degeneration remains unsatisfying. Macular rotation i s so far only a rarely employed surgical procedure, where the macula i s translocated to an area with intact retinal pigment epithelium. The aim of this study was to elucidate the orthoptic problems of macular r otation and describe possible treatment modalities. Patients and metho d Between February and July of 1997 a macular rotation was performed i n 8 patients with exsudative macular degeneration, followed by silicon e oil removal and implantation of an intraocular lens. In 3 out of 8 p atients the oblique muscles were transposed at the beginning of the su rgery to produce an excylotropia. In all patients visual acuity for di stance and near was determined pre-and postoperatively along with a co mplete orthoptic status including measuring of cyclotropia. Mean posto perative follow-up was 5.5 months. Results Due to the unilateral ectop ia of the macula all patients presented with a postoperative strabismu s with vertical deviation of 2 degrees to 10 degrees. The change of th e visual axis resulted in a displacement of the pupillary rifler. The patients described a cyclotropia of 12 degrees to 45 degrees correspon ding to the ophthalmoscopically estimated angle of retinal rotation. P atients after surgery of the oblique muscles showed less cyclotropia w ith an angle of 12 degrees to 20 degrees. They were less disturbed by diplopia and tilted visual impression than those without muscle surger y. All patients exhibited an abnormal head position with chin up and t ilt to the side of the operated eye. Conclusion Macular rotation alway s causes diplopia because of the unilateral ectopia with cyclotropia a nd vertical deviation. These problems can be considerably reduced by c ombining macular rotation surgery with oblique muscles surgery. It may well be that in the future these problems can be completely resolved by additional surgery on the rectus muscles.