Anterior Segment Ischemia after Strabismus Surgery

Abstract

A 46-year-old male patient was referred to our clinic with complaints of diplopia and esotropia in his right eye that developed after a car accident. The patient had right esotropia in primary position and abduction of the right eye was totally limited. Primary deviation was over 40 prism diopters at near and distance. The patient was diagnosed with sixth nerve palsy and 18 months after trauma, he underwent right medial rectus muscle recession. Ten months after the first operation, full-thickness tendon transposition of the superior and inferior rectus muscles (with Foster suture) was performed. On the first postoperative day, slit-lamp examination revealed corneal edema, 3+ cells in the anterior chamber and an irregular pupil. According to these findings, the diagnosis was anterior segment ischemia. Treatment with 0.1/5 mL topical dexamethasone drops (16 times/day), cyclopentolate hydrochloride drops (3 times/day) and 20 mg oral fluocortolone (3 times/day) was initiated. After 1 week of treatment, corneal edema regressed and the anterior chamber was clean. Topical and systemic steroid treatment was gradually discontinued. At postoperative 1 month, the patient was orthophoric and there were no pathologic symptoms besides the irregular pupil. Anterior segment ischemia is one of the most serious complications of strabismus surgery. Despite the fact that in most cases the only remaining sequel is an irregular pupil, serious circulation deficits could lead to phthisis bulbi. Clinical properties of anterior segment ischemia should be well recognized and in especially risky cases, preventative measures should be taken.

Investigation of alterations in retrobulbar hemodynamics and their correlation with choroidal thickness after strabismus surgery

“…Anterior ciliary arteries that provide at least 70–80% of the blood supply to the anterior segment are disrupted during a conventional strabismus surgery [ 3 ]. Interruption of the anterior segment circulation may result in ASI, a serious complication that may occur following strabismus surgery [ 1 ]. A previous experimental study showed that two or three rectus muscle recession in different combinations simultaneously may cause transient mild to moderate ASI, whereas simultaneous recession of four rectus muscles can result in severe ASI [ 10 ].…”

“…Anterior segment ischemia (ASI) is a rare but important complication of extraocular muscle surgery with an incidence ranging from 1/13,000 to 1/30,000 [ 1 ]. Advanced age, hyperviscosity, systemic vascular diseases, hematologic disorders, carotid-cavernous fistula, and 360 O scleral buckling surgery are the risk factors for ASI [ 2 ].…”

“…Advanced age, hyperviscosity, systemic vascular diseases, hematologic disorders, carotid-cavernous fistula, and 360 O scleral buckling surgery are the risk factors for ASI [ 2 ]. Three or more rectus muscle surgery in a single operation, vertical rectus muscle surgery, or a second strabismus surgery within the six months of a previous extraocular muscle surgery may also increase the risk of ASI [ 1 ]. Anterior ciliary arteries are not preserved during a conventional strabismus surgery and reestablishment of flow in these arteries is not possible after surgery.…”

A novel predictive model for phthisis bulbi following facial hyaluronic acid cosmetic injection

“…The syndrome secondary to hypoperfusion of the anterior segment circulation (ASC) caused by various reasons, with clinical characteristics of segmental or circumferential atrophy of the iris, pupil irregularity, uveitis, corneal edema, CHS, hypotony, cataract, even PB [ 10 – 14 ]. Some manifestations are usually not associated with long-term ciliary process dysfunction, such as segmental iris atrophy, pupil irregularity, uveitis, which we call mild ASI (mASI).…”

Management of Duane retraction syndrome: A simplified approach

“…Moreover, in case the MR and LR are both to be operated, adding the SRT or even partial VRT is fraught with the danger of anterior segment ischemia. [20] In cases where the affected eye is the fixing eye, surgery should be performed in the affected fixing eye to ward off the large secondary deviations that occur in non-fixing eye. We generally prefer a “balanced” partial VRT to SRT as the latter has a risk of vertical incomitance and inducing torsion.…”