J Korean Ophthalmol Soc.  2018 Dec;59(12):1195-1200. 10.3341/jkos.2018.59.12.1195.

Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

• Ahn J
• Kim GN
• Kim SJ
• Chung IY
• Seo SW
• Yoo JM

• KMID: 2428694
• DOI: http://doi.org/10.3341/jkos.2018.59.12.1195

Abstract

PURPOSE
To report a case of anterior segment ischemia after superior and inferior rectus muscle surgery in a patient with superior rectus muscle enlargement. This is the first report in the Republic of Korea of anterior segment ischemia after two rectus muscles surgery.
CASE SUMMARY
An 80-year-old male was referred to our clinic with a 3 years history of diplopia. The patient had 30 prism diopters right eye hypertropia in the primary position and downgaze limitation. The orbital computed tomography scan revealed enlargement of the right superior rectus muscle. He underwent right superior rectus recession and inferior rectus resection. On postoperative day 2, slit lamp examination revealed diffuse corneal edema, Descemet's membrane folding, an aqueous flare and a dilated pupil. Treatment with 45 mg oral steroid was initiated, and 1% prednisolone acetate and 0.5% Levofloxacin eye drops were administered. At postoperative 1 month, the patient was orthophoric in the primary position, and there was no corneal edema, pupil abnormality or aqueous flare.
CONCLUSIONS
Base on the present case, the possibility of anterior segment ischemia should be considered after even two muscles surgery, and older patients with vertical muscle surgery should be considered more carefully.

Keyword

Anteior eye segment; Ischemia; Oculomotor muscles

MeSH Terms

Aged, 80 and over
Aqueous Humor
Corneal Edema
Descemet Membrane
Diplopia
Humans
Ischemia*
Levofloxacin
Male
Muscles*
Oculomotor Muscles
Ophthalmic Solutions
Orbit
Prednisolone
Pupil
Republic of Korea
Slit Lamp
Strabismus
Ophthalmic Solutions
Prednisolone

Figure

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  Figure 1 Preoperative 9 cardinal photographs show 30 prism diopters right eye hypertropia in the primary position and right eye down gaze limitation. The right eye subconjunctival hemorrhage was caused by forced duction test.

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  Figure 2 Preoperative enhanced computed tomography. The image reveals right superior rectus muscle enlargement.

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  Figure 3 Anterior segment photograph. (A) Diffuse corneal edema, Descemet's membrane folding and 5 mm sized pupil dilatation were identified after 2 days of surgery. (B) Clear cornea and no pupil dilatation were observed after 6 days of surgery.

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  Figure 4 Nine cardinal photographs at postoperative 1 month. The patient was orthophoric in the primary position, and down gaze limitation of the right eye was improved.

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