98th Annual Meeting DOG 2000

V 561

Cyclotropia following macular translocation: possible approaches for strabismus surgery

J. Fricke, A. Neugebauer, I. Köchling, W. Rüssmann

Consecutive to macular translocation often surgical interventions on the eye muscles for reduction of cyclotropia and sometimes vertical tropia are necessary. Namely cyclotropia can show dimensions that by 30-45° surpass the amounts which in strabismus surgery usually have to be reduced. Thus the standard surgical procedures for reduction of cyclotropia have to be extended or modified either by combination of hitherto usual approaches or by introduction of new surgical techniques. Limitation of surgery on the recti by the risk of anterior segment ischemia has to be realized. In 75 patients we performed eye muscle surgery with the intention to reduce cyclotropia emerging with macular translocation. 55 patients were operated on the eye muscles in the same surgical session with the retinal rotation, 20 patients were operated on in a second operation, i.e. after retinal translocation - mostly together with the removal of the silicone oil tamponade about eight weeks after primary retinal surgery.

Pre- and postoperatively subjective cyclorotation was measured with the Maddox-cylinder and at the light-bar of the Harms´screen. By this the reduction of cyclotropia which resulted from the different surgical approaches applied, could be analyzed. 

We studied the counterrotating effect of the following surgical procedures:
Partial transposition of all four recti (transposition of ½ of the muscle insertion) combined with recession and plication on the oblique eye muscles.
Partial transposition on all four recti by desinsertion of a ¼ width muscle strip and undercrossing the muscle with it combined with the above named surgery on the oblique eye muscles.

Isolated maximum surgery on both oblique eye muscles. Complete transposition surgery on two recti together with surgery on both oblique eye muscles. Complete transposition of the superior oblique with transposition of the medial rectus.

Universitäts-Augenklinik Köln, J. Stelzmann Str. 9, 50931 Köln