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Anterior segment ischemia: etiology, assessment, and management.

Publication ,  Journal Article
Pineles, SL; Chang, MY; Oltra, EL; Pihlblad, MS; Davila-Gonzalez, JP; Sauer, TC; Velez, FG
Published in: Eye (London, England)
February 2018

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.

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Published In

Eye (London, England)

DOI

EISSN

1476-5454

ISSN

0950-222X

Publication Date

February 2018

Volume

32

Issue

2

Start / End Page

173 / 178

Related Subject Headings

  • Strabismus
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Ophthalmology & Optometry
  • Ophthalmologic Surgical Procedures
  • Oculomotor Muscles
  • Ischemia
  • Humans
  • Eye Diseases
 

Citation

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Pineles, S. L., Chang, M. Y., Oltra, E. L., Pihlblad, M. S., Davila-Gonzalez, J. P., Sauer, T. C., & Velez, F. G. (2018). Anterior segment ischemia: etiology, assessment, and management. Eye (London, England), 32(2), 173–178. https://doi.org/10.1038/eye.2017.248
Pineles, S. L., M. Y. Chang, E. L. Oltra, M. S. Pihlblad, J. P. Davila-Gonzalez, T. C. Sauer, and F. G. Velez. “Anterior segment ischemia: etiology, assessment, and management.Eye (London, England) 32, no. 2 (February 2018): 173–78. https://doi.org/10.1038/eye.2017.248.
Pineles SL, Chang MY, Oltra EL, Pihlblad MS, Davila-Gonzalez JP, Sauer TC, et al. Anterior segment ischemia: etiology, assessment, and management. Eye (London, England). 2018 Feb;32(2):173–8.
Pineles, S. L., et al. “Anterior segment ischemia: etiology, assessment, and management.Eye (London, England), vol. 32, no. 2, Feb. 2018, pp. 173–78. Epmc, doi:10.1038/eye.2017.248.
Pineles SL, Chang MY, Oltra EL, Pihlblad MS, Davila-Gonzalez JP, Sauer TC, Velez FG. Anterior segment ischemia: etiology, assessment, and management. Eye (London, England). 2018 Feb;32(2):173–178.

Published In

Eye (London, England)

DOI

EISSN

1476-5454

ISSN

0950-222X

Publication Date

February 2018

Volume

32

Issue

2

Start / End Page

173 / 178

Related Subject Headings

  • Strabismus
  • Retrospective Studies
  • Prospective Studies
  • Postoperative Complications
  • Ophthalmology & Optometry
  • Ophthalmologic Surgical Procedures
  • Oculomotor Muscles
  • Ischemia
  • Humans
  • Eye Diseases