Anterior segment ischemia following modified Nishida procedure

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.