Journal of The Korean Ophthalmological Society (대한안과학회지)

The Korean Ophthalmological Society (대한안과학회)
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Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

두 개의 수직근수술 후 발생한 전안부허혈 1예

  • Ahn, Jayoung (Department of Ophthalmology, Gyeongsang National University College of Medicine) ;
  • Kim, Gyu Nam (Department of Ophthalmology, Gyeongsang National University College of Medicine) ;
  • Kim, Seong Jae (Department of Ophthalmology, Gyeongsang National University College of Medicine) ;
  • Chung, In Young (Department of Ophthalmology, Gyeongsang National University College of Medicine) ;
  • Seo, Seong Wook (Department of Ophthalmology, Gyeongsang National University College of Medicine) ;
  • Yoo, Ji Myong (Department of Ophthalmology, Gyeongsang National University College of Medicine)
  • 안자영 (경상대학교 의과대학 안과학교실) ;
  • 김규남 (경상대학교 의과대학 안과학교실) ;
  • 김성재 (경상대학교 의과대학 안과학교실) ;
  • 정인영 (경상대학교 의과대학 안과학교실) ;
  • 서성욱 (경상대학교 의과대학 안과학교실) ;
  • 유지명 (경상대학교 의과대학 안과학교실)
  • Received : 2018.04.19
  • Accepted : 2018.11.22
  • Published : 2018.12.15
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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.

목적: 상직근 비대가 동반된 환자에서 상직근 및 하직근 수술 이후 발생한 전안부허혈을 경험하였으며, 현재까지 두 개의 직근수술 이후 발생한 전안부허혈은 국내에서 보고된 바 없어 이를 보고하고자 한다. 증례요약: 80세 남자 환자가 3년 전부터 발생한 복시를 주소로 내원하였다. 제일눈위치에서 30프리즘디옵터의 우안 상사시를 보였고, 눈운동검사에서 우안의 하전운동장애가 관찰되었다. 안와 전산화단층촬영검사에서 우안 상직근 비대 소견이 관찰되었다. 우안 상직근 후전술 및 하직근절제술을 시행하였다. 수술 후 2일째 전안부 검사상 우안의 미만성 각막부종과 데스메막주름이 관찰되었고, 전방 방수흐림 및 동공산대가 관찰되었다. 전안부허혈 진단하에 경구 스테로이드 45 mg으로 치료를 시작하였으며, 1% prednisolone acetate와 0.5% levofloxacin 점안약을 사용하였다. 수술 후 1개월째 제일눈위치에서 정위를 보였고 각막부종, 동공이상이나 전방의 염증은 관찰되지 않았다. 결론: 본 증례를 통해 두 개의 직근을 수술할 때도 전안부허혈의 발생 가능성을 항상 염두에 두어야 함을 알 수 있으며, 고령의 환자에서 수직근수술을 시행할 때 더욱 주의할 것을 권유한다.

Keywords

References

  1. Wright KW. Color Atlas of Strabismus surgery: Strategies and techniques, 3rd ed. New York: Springer, 2007;100-1.
  2. Virdi PS, Hayrey SS. Anterior segment ischemia after recession of various recti. An experimental study. Ophthalmology 1987;94:1258-71. https://doi.org/10.1016/S0161-6420(87)80009-X
  3. Olver JM, Lee JP. The effects of strabismus surgery on anterior segment circulation. Eye (Lond) 1989;3:318-26. https://doi.org/10.1038/eye.1989.46
  4. France TD, Simon JW. Anterior segment ischemia syndrome following muscle surgery: the AAPO&S experience. J Pediatr Ophthalmol Strabismus 1986;23:87-91.
  5. Olver JM, Lee JP. Recovery of anterior segment circulation after strabismus surgery in adult patients. Ophthalmology 1992;99:305-15. https://doi.org/10.1016/S0161-6420(92)31971-2
  6. Girard LJ, Beltranena F. Early and late complications of extensive muscle surgery. Arch Ophthalmol 1960;64:576-84. https://doi.org/10.1001/archopht.1960.01840010578016
  7. Saunders RA, Sandall GS. Anterior segment ischemia syndrome following rectus muscle transposition. Am J Ophthalmol 1982;93:34-8. https://doi.org/10.1016/0002-9394(82)90695-X
  8. Bleik JH, Cherfan GM. Anterior segment ischemia after the Jensen procedure in a 10-year-old patient. Am J Ophthalmol 1995;119:524-5. https://doi.org/10.1016/S0002-9394(14)71248-6
  9. Saunders RA, Bluestein EC, Wilson ME, Berland JE. Anterior segment ischemia after strabismus surgery. Surv Ophthalmol 1994;38:456-66. https://doi.org/10.1016/0039-6257(94)90175-9
  10. Jacobs DS, Vastine DW, Urist MJ. Anterior segment ischemia and sector iris atrophy: after strabismus surgery in a patient with chronic lymphocytic leukemia. Ophthalmic Surg 1976;7:42-8.
  11. Hiatt RL. Production of anterior segment ischemia. J Pediatr Ophthalmol Strabismus 1978;15:197-204.
  12. Elas FJ, Witherspoon CD. Anterior segment ischemia after strabismus surgery in a child. Am J Ophthalmol 1987;103:833-4. https://doi.org/10.1016/S0002-9394(14)74407-1
  13. Krewson WE 3rd. Ocular tendon transplantation, indication, variations and technic. J Int Coll Surg 1957;27:731-7.
  14. Harley RD. Complete tendon transplantation for ocular muscle paralysis. Ann Ophthalmol 1971;3:459-63.
  15. McKeown CA, Lambert HM, Shore JW. Preservation of the anterior ciliary vessels during extraocular muscle surgery. Ophthalmology 1989;96:498-506. https://doi.org/10.1016/S0161-6420(89)32867-3
  16. Murdock TJ, Mills MD. Anterior segment ischemia after strabismus surgery with microvascular dissection. J AAPOS 2000;4:56-7. https://doi.org/10.1016/S1091-8531(00)90013-2
  17. Velez FG, Demer JL, Pihlblad MS, Pineles SL. Rectus muscle plication using an adjustable suture technique. J AAPOS 2013;17:480-3. https://doi.org/10.1016/j.jaapos.2013.06.002
  18. Enzmann DR, Donaldson SS, Kriss JP. Appearance of Graves's disease on orbital computed tomography. J Comput Assist Tomogr 1979;3:815-9. https://doi.org/10.1097/00004728-197903060-00019
  19. Fells P, Marsh RJ. Anterior segment ischemia following surgery on two rectus muscles. In: Reinecke R, ed. Strabismus: proceedings of the third meeting of the International Strabismological Association, 1st ed. New York: Grune & Stratton, 1978; 375-80.
  20. Morrison JC, Van Buskirk EM. Anterior collateral circulation in the primate eye. Ophthalmology 1983;90:707-15. https://doi.org/10.1016/S0161-6420(83)34501-2
  21. Wilcox LM, Keough EM, Connolly RJ, Hotte CE. The contribution of blood flow by the anterior ciliary arteries to the anterior segment in the primate eye. Exp Eye Res 1980;30:167-74. https://doi.org/10.1016/0014-4835(80)90110-4
  22. Yip WW, Yu CB, Fan DS, et al. Anterior segment ischemia after two-muscle surgery in a patient with radiation-treated nasopharyngeal carcinoma. J Pediatr Ophthalmol Strabismus 2008;45:40-2. https://doi.org/10.3928/01913913-20080101-22
  23. Raizman MB, Beck RW. Iris ischemia following surgery on two rectus muscles. Arch Ophthalmol 1985;103;1783, 1787.