Abstract

SO.13.03

Anterior segment ischaemia after eye muscle surgery

Oliver Ehrt
Augenklinik der Ludwig-Maximilians-Universität München, München

Objective
Severe, vision threatening complications are rare in eye muscle surgery: endophthalmitis (1:10.000 - 1:30.000), scleral perforation with rare choroidal haemorrhage or retinal detatchment and ischaemia of the anterior segment. Symptoms of ischaemia occur within hours after the operation: severe pain, visual acuity loss, distorted and dilated pupil, corneal oedema with descemet folds, anterior chamber flare, hypotony, secundäry cataract, iris atrophy.
Methods
A questionaire was sent to 40 strabismus surgeon in Germany, Switzerland and Austria, retrospective case series
Results
The analysis of my own case and 11 reported cases showed:
The incidence was estimated at 1:10.000. Pre-existing ocular disease was present in 3 patients (all Grave's orbitopathy, 1x after orbital decompression), 2x previous eye muscle surgery. 1x child (very mild anterior chamber reaction), else 50-75 years, 6x vascular risk factors. The ischemia occurred after these operations: 5x OP of two vertical rectus muscles (2x tuck, 2x partial transposition), 3x OP of 2 horizontal muscles, 1x medial rectus recession. All patients recovered full prae-op visual acuity within 2 - 10 weeks. Anisocoria persisted in all, 1x complete iris atrophy. The strabismological result was not significantly affected by the ischaemia. No treatment could be compared.
Conclusions
Anterior segment ischaemia is a severe complications of eye muscle surgery with an good prognosis. Except for 3 patients with Grave's orbitopathy and 1 patient with previous surgery, there was no local predisposing factor. There was only one patient with operations on four eye muscles in the series.

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