Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

Jayoung Ahn; Gyu Nam Kim; Seong Jae Kim; In Young Chung; Seong Wook Seo; Ji Myong Yoo

doi:10.3341/jkos.2018.59.12.1195

Journal List > J Korean Ophthalmol Soc > v.59(12) > 1109309

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Ahn, Kim, Kim, Chung, Seo, and Yoo: Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

Case Report

Journal of the Korean Ophthalmological Society 2018; 59(12): 1195-1200.

Published online: 17 December 2018

DOI: https://doi.org/10.3341/jkos.2018.59.12.1195

Case of Anterior Segment Ischemia after Two Vertical Rectus Muscles Surgery

Jayoung Ahn, MD¹, Gyu Nam Kim, MD¹, Seong Jae Kim, MD, PhD^1,², In Young Chung, MD, PhD^1,², Seong Wook Seo, MD, PhD^1,², Ji Myong Yoo, MD, PhD^1,²

¹Department of Ophthalmology, Gyeongsang National University College of Medicine, Jinju, Korea.

²Gyeongsang Institute of Health Science, Gyeongsang National University, Jinju, Korea.

Address reprint requests to Ji Myong Yoo, MD, PhD. Department of Ophthalmology, Gyeongsang National University Hospital, #79 Gangnam-ro, Jinju 52727, Korea. Tel: 82-55-750-8171, Fax: 82-55-758-4158, yjm@gnu.ac.kr

Received 19 April 2018 Revised 9 July 2018 Accepted 22 November 2018

The Korean Ophthalmological Society

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Anteior eye segment, Ischemia, Oculomotor muscles

Figures and Tables

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.

Figure 2

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

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.

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.

Notes

^{Conflicts of Interest} The authors have no conflicts to disclose.

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