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Anterior segment ischemia following modified Nishida procedure
Malik Moledina1, Ayman Awadghanem1, Anugia Agrawal1
1Southend University Hospital NHS Foundation Trust, Southend-on-Sea, United Kingdom.
Abstract:
Anterior segment ischemia (ASI) can occur following strabismus surgery on multiple muscles. Procedures such as modified Nishida procedure (MNP) have been developed to reduce the risk of ASI. We report the case of a 68-year-old patient presenting with traumatic bilateral abducens nerve palsies who required surgical intervention. We performed MNP with medial rectus recession. The patient presented with reduced vision, corneal edema, anterior chamber reaction, and pupillary dilation 24 hours after surgery. A diagnosis of ASI was made, and immediate reversal of the Nishida procedure was performed. Symptoms improved within 24 hours. In this case, ASI may have been caused by ligation and compression of ciliary arteries due to overstretching of the vertical rectus muscles during transposition.
Insights
Anterior segment ischemia (ASI) can occur after strabismus surgery. A modified Nishida procedure (MNP) reversal successfully treated ASI in a patient with bilateral abducens nerve palsies.
Area of Science:
- Ophthalmology
- Surgical Complications
- Ocular Anatomy
Background:
- Anterior segment ischemia (ASI) is a potential complication of strabismus surgery, particularly when multiple muscles are involved.
- The modified Nishida procedure (MNP) was developed to mitigate the risk of ASI.
- Traumatic bilateral abducens nerve palsies necessitate complex surgical interventions.
Observation:
- A 68-year-old patient with bilateral abducens nerve palsies underwent MNP with medial rectus recession.
- Postoperatively, the patient exhibited symptoms indicative of ASI: reduced vision, corneal edema, anterior chamber reaction, and pupillary dilation.
- ASI was diagnosed 24 hours after the strabismus surgery.
Findings:
- Immediate reversal of the modified Nishida procedure was performed.
- The patient's ASI symptoms resolved within 24 hours following the reversal.
- The case suggests ASI may result from ciliary artery compromise due to muscle overstretching during transposition.
Implications:
- Prompt recognition and surgical reversal are crucial for managing ASI post-strabismus surgery.
- Careful surgical technique, particularly regarding muscle tension and transposition, is vital to prevent vascular compromise.
- This case highlights a potential mechanism of ASI related to MNP and vertical rectus muscle manipulation.
