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Impressum
Diplopia and confusion after macular translocation: What is the role of the postoperative visual acuity?
Eckardt U., Eckardt C.
Augenklinik der Städt. Kliniken Frankfurt a.M.-Höchst, Gotenstraße 6-8, 65929 Frankfurt
Translocation of the fovea in macular rotation surgery (MT) usually leads
to binocular problems with diplopia and confusion caused by cyclotropia
and secondary strabismus. Usually these problems can be prevented by muscles
surgery with counter rotation of the globe. In this retrospective study
we investigated the strabological problems despite muscle surgery with
respect to the visual acuity of the operated eye and the fellow eye.
Materials and Methods: Between February 1997 and March 2001 134
patients were treated for age related macular degeneration by retinal
rotation of 20 to 50° upward: In all cases the macular-rotated eye
was treated with combined surgery of the oblique muscles and splitting
of 2 to 4 rectus muscles. In 94 patients additional primary or secondary
muscle surgery of the fellow eye was carried out for treatment for vertical
and horizontal and remaining cyclotropias.
Results: In 75 patients the difference between the postoperative
far visual acuity of the macular-rotated eye and the fellow eye was 1
or 2 lines or even equal. Despite of the muscle surgery 12 of the 75 patients
had disturbing diplopia and a tilted image. Four of the 12 patients achieved
freedom from complaints with prisms. In 59 patients the difference between
the postoperative far visual acuity of the macular-rotated eye and the
fellow eye was greater than 2 lines. In this group 10 of the 59 patients
had still diplopia and cyclotropia. Six of these 10 patients could be
treated successfully with prisms.
Conclusions: In the majority of cases torsional muscle surgery
with counter rotation of the globe enables the compensation of the retinal
rotation of up to 50° without diplopia and disturbing tilted image.
A risk factor for persistent diplopia and disturbing tilted image seems
not to be correlated with a low postoperative visual acuity of the macular-rotated
eye. Other factors seems to play a more important role.