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Impressum
Combined transposition of the superior oblique - a treatment option for large cyclodeviations consecutive to macular translocation
Fricke J., Neugebauer A., Rüssmann W.
Universitäts-Augenklinik Köln
In consequence of macular translocation for treatment of age related
maculadegeneration sometimes large incyclodeviations have to be neutralized
by eye muscle surgery. By combination of a high dosage recession and plication
or advancement of the oblique muscles respectively of their anterior margins
together with partial or total transposition of the recti (by sparing
of the anterior segment perfusion) we could reduce incyclorotation on
average by 22°. This amount in single cases is not large enough to
deminish the existing cyclodeviation to values that can be overcome by
fusion or exclusion. The full tendon transposition of the insertion of
the superior oblique from the superior temporal quadrant of the globe
to an inferior nasal position directs the incyclorotational force to an
excyclorotational one. Thus this procedure in combination with the excyclorotatory
procedures on the inferior oblique and/or the recti promises augmented
effects compared to the combinations with superior oblique recession.
Nevertheless as to anterior segment perfusion the transposition of the
superior oblique is neutral. We performed this transposition in 5 patients
combined with advancement of the anterior margin of the inferior oblique
together with silicone oil removal after macular translocation. Angle
of squint, monocular cyclodeviation and eye motility were evaluated pre-
and postoperatively. Preoperative incyclodeviation was 33,4° on average.
The reduction attained was 22° on average. The combined transposition
of the superior oblique tendon to the nasal position of the globe enlarges
the spectrum of methods available for muscular counterrotation after macular
translocation. Especially in regard to risk situations with reduced anterior
segment perfusion this procedure could be beneficial.