Preservation of Anterior Ciliary Vessels in Strabismus Surgery

ABSTRACT

Anterior segment ischemia syndrome is caused by disruption of anterior ciliary vessels at surgery on multiple rectus muscles in strabismus. Staging surgery has been recommended when more than 3 rectus muscles are to be tenotomized. The purpose of this study is to prevent anterior segment ischemia syndrome using the technique of anterior ciliary vessels under the surgical microscope, and correct paralytic and complicated strabismus at one surgery. Six patients underwent preservation of anterior ciliary vessels. Five patients had sixth nerve palsy in one eye. First, superior and inferior rectus muscles were transposed, then medial rectus was recessed with preservation of anterior ciliary vessels. Four were successful, but one was failed and needed second operation. Another patient showed exotropia and hypetropia of amblyopic eye, in which recession of lateral rectus and resection of medial rectus, and recession of superior rectus with preservation of its anterior ciliary vessels were performed. All the patients showed orthoporia without anterior segment ischemia. This study suggests that the preservation of anterior ciliary vessels of rectus muscles is a very delicate and time-consuming procedure, but effective in preventing anteior segment ischemia syndrome and reducing the number of surgery.