Anterior Ciliary Vessel Preservation During Rectus Muscle Surgery

Abstract

Anterior segment ischemia (ASI) is a rare but potentially serious complication of retinal detachment repair and strabismus surgery. A number of risk factors for ASI have been identified but none are consistently predictive and no reliable laboratory tests have been developed to establish patient susceptibility. Certain surgical modifications may reduce damage to the anterior ciliary vessels (ACV) including the use of the fornix approach (Fishman, 1989) and muscle splitting techniques which attempt to leave half of the tendon undisturbed. In addition, surgeons often follow certain guidelines in an effort to avoid ASI. These include consideration of the patient’s age, the presence of certain systemic diseases, limiting the number of operated muscles, and staging the surgery to allow for ACV revascularization. Recent primate studies raise questions regarding revascularization. (Olver, 1989) Unfortunately, ASI has been reported following surgery on as few as two rectus muscles, after muscle splitting procedures, and after prolonged intervals with staged surgery.