Anterior segment ischemia: etiology, assessment, and management
| Autor: | Stacy L. Pineles, Matthew S. Pihlblad, Juan P. Davila-Gonzalez, E. L. Oltra, Federico G. Velez, Melinda Y. Chang, T. C. Sauer |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Eye Diseases genetic structures Ophthalmologic Surgical Procedures 03 medical and health sciences Postoperative Complications 0302 clinical medicine Anterior Segment Ischemia Anterior Eye Segment Ischemia medicine Humans Prospective Studies Strabismus Retrospective Studies Diplopia medicine.diagnostic_test business.industry Retrospective cohort study Blood flow Cambridge Ophthalmological Symposium eye diseases Surgery Ophthalmology Oculomotor Muscles Angiography 030221 ophthalmology & optometry medicine.symptom Complication business 030217 neurology & neurosurgery Strabismus surgery |
| Zdroj: | Eye. 32:173-178 |
| ISSN: | 1476-5454 0950-222X |
| DOI: | 10.1038/eye.2017.248 |
| Popis: | Anterior segment ischemia (ASI) is a potentially serious but rare complication of strabismus surgery. Among several risk factors, ASI occurs after strabismus surgery because of the nature of the anterior segment circulation. Disinsertion of rectus muscles leads to a decrease in the blood supply to the various anterior segment structures. We report a series of retrospective and prospective studies performed by our group focused on determining the risk of anterior segment ischemia following strabismus surgery, diagnosis, and modifications to surgical techniques to minimize the impact on anterior segment circulation. We found a significant decrease in postoperative anterior segment blood flow when operating vertical rectus muscles. Plication procedures preserve anterior segment circulation, and modifications to the technique allow the performance of adjustable sutures. Small adjustable selective procedures that spare the ciliary vessels have been demonstrated to be effective in patients with vertical and torsional diplopia. Ciliary sparing augmented adjustable transposition surgery decreases the risk of anterior segment ischemia while allowing management of potential post-operative alignment complications. Finally, ocular coherence tomography angiography is a valuable quantitative and qualitative technique to evaluate anterior segment ischemia. Strabismus surgeons should be aware of the risks of anterior segment ischemia when operating vertical rectus muscles. Modifications to standard surgical techniques allow surgeons to perform complex strabismus surgery in patients at risk for anterior segment ischemia. |
| Databáze: | OpenAIRE |
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