[Surgical management of monocular torsion and head tilt after macular translocation].
BACKGROUND
Macular translocation following 360 degrees retinotomy is a possible surgical treatment of patients with age-related macular degeneration. However, it produces important subjective disturbances with diplopia and head tilt due to cyclodeviation. Complex surgical procedures involving both oblique muscles and two or four recti have been advocated.


METHODS
Four symptomatic patients with macular translocation underwent counter-rotating surgery by very large recession and advancement of both oblique muscles of the affected eye. Preoperative subjective cyclo-deviations varied between 25 degrees and 60 degrees and head tilt ranged between 25 degrees and 45 degrees .


RESULTS
Reduction of cyclodeviation ranged between 22 degrees ant 30 degrees in our four patients. Two patients showed residual cyclo-deviations of 3 degrees and 7 degrees with complete recovery of the head tilt. The remaining two patients showed significant subjective improvements and important reductions of head tilt, in spite of a large residual cyclodeviation. No patient exhibited binocular vision.


CONCLUSIONS
Without jeopardizing the anterior segment blood supply of these elderly patients, a combined surgical procedure on both oblique muscles has shown to be sufficiently effective in reducing subjective cyclodeviation and head tilt in four cases of macular translocation. A complete counter-rotation does not seem to be required to achieve an important improvement of subjective symptoms. This may be due to sensorial adaptation.
Klainguti
G
G
Hôpital Jules Gonin, Service Universitaire d'Ophtalmologie de Lausanne, Suisse. georges.klainguti@ophtal.vd.ch
Nguyen
C
C
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D007839:Functional Laterality / Q000502:physiology*; D006801:Humans; D008266:Macula Lutea / Q000503:physiopathology / Q000601:surgery*; D008268:Macular Degeneration / Q000503:physiopathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000503:physiopathology / Q000601:surgery; D009801:Oculomotor Muscles / Q000503:physiopathology / Q000601:surgery*; D017060:Patient Satisfaction; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D012160:Retina / Q000503:physiopathology / Q000601:surgery; D013285:Strabismus / Q000503:physiopathology / Q000601:surgery; D014103:Torticollis / Q000503:physiopathology / Q000601:surgery*