Letter to the Editor: Marlow Occlusion: Reply to the Letter by Michael Brodsky

Purpose. Macular translocation is an optional surgical treatment for age-related macular degeneration. However, this technique induces postoperative torsional complaints and surgical counterrotation of the globe is mandatory. The purpose of this study is to report the effect of compensatory extraocular muscle surgery upon the torsional complaints in patients who underwent a macular translocation procedure. Design. The pre- and postoperative data on the first 35 patients in our department who underwent a counterrotation procedure after macular translocation surgery are reviewed. Methods. From November 2001 to January 2005, 35 patients underwent a macular translocation procedure, with subsequent extraocular muscle surgery to counterrotate the eye. Three types of rectus muscle transposition procedures were used: full-tendon transposition of two opposite rectus muscles, “crossed” half-tendon transposition of all rectus muscles (‘split &; cross’ procedure), and “uncrossed” half-tendon transposition of all rectus muscles (‘split &; neighbor cross’ procedure). In the majority of patients these procedures were associated with oblique muscle surgery. Results. With the selected procedures, retinal excyclodeviations are easier to correct then retinal incyclodeviations. In our hands, full-tendon transposition of two opposite rectus muscles with or without associated oblique muscle surgery, never corrects more than 30°. ‘Split &; cross’ procedures combined with oblique muscle surgery are sufficient for retinal excyclodeviations of 30–45° and for incyclodeviations of up to 30°; ‘split &; neighbor cross’ procedures combined with oblique muscle surgery are sufficient for retinal excyclodeviations of 45–65° and for incyclodeviations of up to 40°. Conclusions. The effect of the various procedures appears to be predictable. It is possible to select a surgical procedure as a function of the amount of retinal cyclodeviation.