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INTRODUCTION Age-related macular degeneration is the most common causeof irreversible loss of visual acuity, including the ability to read, in elderlypatients. One of the surgical treatment options is macular translocation with360° retinotomy. The orthoptic results of torsional muscle surgery asa second procedure are demonstrated. MATERIALS AND METHODS Between January 1999 and December 2000, the maculawas rotated upward by 12–45° in 10 eyes following complete artificialdetachment and a 360° retinotomy. In these patients, torsional surgerywas carried out as a second procedure. Depending on the resulting cyclotorsion,we performed surgery on the oblique muscles only in four patients with a cyclotropiaof 12–20° and a combination of oblique muscle surgery with surgeryof two or four rectus muscles in the remaining six eyes (cyclotropia over21°). The pre- and postoperative diagnostic techniques included visualacuity, reading vision and the orthoptic status. RESULTS Due to the unilateral ectopia of the macula, all patients presentedpostoperative strabismus with a vertical deviation of 2–10° anda subjective cyclotropia between 12° and 40°. After surgery on theoblique muscles, the patients showed a residual cyclotropia of 0–6°.In patients in whom surgery on the oblique muscles was accompanied by rectusmuscle surgery, the remaining cyclotorsion was 5–13°. Four patientsexcluded the non-operated fellow eye, six patients experienced double visionunder binocular conditions and thus required prescription of additional prismglasses. CONCLUSION Macular translocation causes diplopia under binocular conditionsbecause of the unilateral ectopia of the macular region with cyclotropia andvertical deviation. These problems can be resolved or reduced by oblique musclesurgery or in combination with additional surgery on the rectus muscles, dependingon the range of the cyclotorsion. Performing the... [ABSTRACT FROM AUTHOR]

Background: Previous studies have shown that patients suffering from endocrine orbitopathy (EO) seem to present with profound asymmetry in proptosis. As asymmetry might pose a major problem in planning decompression surgery, information on the amount of variation between sides and a concise evaluation method should be available. Therefore, a study based on a concise 3D cephalometric analysis was conceived to evaluate globe position., Methods: A 3D-cephalometric analysis was performed on computed tomography (CT) data from 52 orbitopathy and 54 control data sets. Using 36 anatomic landmarks, 33 distances were evaluated to measure sagittal, vertical, and horizontal globe position., Results: EO patients presented with marked exophthalmos and statistically significant asymmetry. Depending on the 2 measured distances, 38% and 42%, respectively, presented sagittal asymmetry of >2 mm, and 12% and 13%, respectively, presented with sagittal asymmetry >4mm. No such asymmetry was seen in the control group. Furthermore, EO patients showed a larger interglobe distance due to lateral globe position. Marked asymmetry correlated with male sex. Proptosis measured to the deep bony orbit correlated with values measured to the orbital aperture or with constructed Hertel values., Conclusions: Use of 3D cephalometry and CT-based analysis confirmed findings from previous clinical studies on profound sagittal asymmetry in EO. Endocrine orbitopathy leads to a sagittal-lateral globe displacement that is even more pronounced in the current study than in earlier investigations. Concerning surgical therapy, presurgical asymmetry, especially if profound, has to be considered to achieve an esthetic symmetrical outcome. Use of 3D orbital analysis is an appropriate method to describe globe position beyond clinical measurements., Competing Interests: Disclosures: The authors declared no conflicts of interest with respect to the research, authorship, and/or publication of this article.

Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht.

Competing Interests: Interessenkonflikt: Die Autoren geben an, dass kein Interessenkonflikt besteht.