Surgical rotation of the eyeball

Abstract

For the purpose of treating retinal detachments with large tears or disinsertions in the upper quadrants the surgical rotation of the eyeball was carried out in five cases in order to bring the tears towards the lower part orbit. The rectus muscles were sectioned, the globe rotated 90°, and the muscle ends sutured to the stumps lying opposite. Conventional scleral buckling (or scleral resection) was done first as in the usual treatment of retinal detachment. It was not possible to accomplish a rotation of more than 90° owing to retinal ischaemia. After a few months, when the detached retina was successfully reapposed the eyeball was again rotated to its original position. This operation was successful in only two of the five cases. While the eye remained rotated the visual acuity and ocular movements were studied. Objects of regard were seen with an inclination of 90° in opposite direction to that of the rotation. The motility of the rotated eye showed that there was a definite dissociation between the voluntary and labyrinthine movements and those of retinal origin (optically elicited). The former were performed normally, but those of retinal origin were made with a 90° inclination. This demonstrated the existence of a close association between the retinal meridians and the ocular muscles habitually related thereto, which does not disappear despite eye rotation. The muscular response is conditioned by the maculofugal or maculopetal quality of the stimulus. In rotated eyes the macular fixation reflex is absent when the peripheral retina is stimulated; a muscle contracts other than that necessary for macular fixation and the eye moves to a new position, where another extramacular point is stimulated. Some of these observations on retinomuscular relationships bear out the observations of Stone (1951), and others call for experimental confirmation which is now being sought. The small number of cases studied prevents us from drawing firm conclusions regarding the value of this method of treatment, and the successful results obtained by present-day methods of diathermy with the eye in the normal position, limit the scope of the procedure described.