The effect of rectus muscle recession, resection and plication on anterior segment circulation in humans
- 23 October 2014
- journal article
- research article
- Published by BMJ in British Journal of Ophthalmology
- Vol. 99 (4), 556-560
- https://doi.org/10.1136/bjophthalmol-2014-305712
Abstract
Background Plication is an alternative tightening procedure to resection. In monkeys, plication has been shown to preserve anterior segment circulation compared with full-tendon tenotomy, but this is unconfirmed in humans. Purpose To evaluate anterior segment circulation by iris angiography before and after strabismus surgery in humans. Methods Prospective, blinded study of 14 patients (mean age (SD), 58.6 (14.3)) undergoing plication and/or full tendon tenotomy (resection or recession) from August 2013 to March 2014. Eight patients (mean age (SD), 59.0 (13.3)) underwent plication of one muscle with or without recession of a second muscle on the same eye and six patients (mean age (SD), 58.2 (16.8)) underwent tenotomy of one to two muscles on the same eye. Preoperative and postoperative iris angiograms were compared for changes in perfusion by a masked examiner. In patients undergoing binocular surgery, one eye was chosen preoperatively to be the study eye. Results Postoperative iris filling defects were present in four patients (67%) after tenotomy and one patient (12.5%) after plication (p=0.09). Of the seven total vertical rectus muscles operated (three tenotomies and four plications), filling defects were present after three tenotomies and one plication (100% vs 25%; p=0.14). Of the 13 total horizontal rectus muscles operated (eight tenotomies and five plications), filling defects were present after one tenotomy and none of the plications (13% vs 0%; p=0.99). Conclusions Rectus muscle plication spares the ciliary vessels and may be considered a safer alternative to resection for patients at risk for anterior segment ischaemia, especially when surgery involves a vertical rectus muscle.Keywords
This publication has 19 references indexed in Scilit:
- Natural course of anterior segment ischemia after disinsertion of extraocular rectus muscles in an animal modelJournal of American Association for Pediatric Ophthalmology and Strabismus, 2013
- A Modified Technique for Rectus Muscle Plication in Minimally Invasive Strabismus SurgeryOphthalmologica, 2010
- Anterior segment ischemia following augmented 2-muscle transposition surgeryJournal of American Association for Pediatric Ophthalmology and Strabismus, 2004
- Indocyanine green angiography of the anterior segment in patients undergoing strabismus surgeryBritish Journal of Ophthalmology, 2001
- Anterior segment ischemia after strabismus surgerySurvey of Ophthalmology, 1994
- Recovery of Anterior Segment Circulation after Strabismus Surgery in Adult PatientsOphthalmology, 1992
- Anterior Segment Ischemia after Three Rectus Muscle SurgeryOphthalmology, 1988
- Anterior Segment Ischemia after Recession of Various RectiOphthalmology, 1987
- Iris Ischemia Following Surgery on Two Rectus MusclesAmerican Journal of Ophthalmology, 1985
- The contribution of blood flow by the anterior ciliary arteries to the anterior segment in the primate eyeExperimental Eye Research, 1980