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Anterior Segment Ischemia Following Vertical Muscle Transposition and Botulinum Toxin Injection

Anterior Segment Ischemia Following Vertical Muscle Transposition and Botulinum Toxin Injection Abstract To the Editor. —We read with interest the case report by Keech et al1 in the February 1990 issue of the Archives.This interesting report raises a number of matters that we would like to address. First, many authors, including Hayreh and Scott,2 Virdi and Hayreh,3 and us,4 have pointed out that the contribution of the anterior ciliary vessels of the vertical recti is variable and may be extensive. Under certain circumstances disinsertion of both vertical recti may be capable of causing mild anterior segment ischemia, ie, postoperative anterior chamber activity, sphincter abnormalities, and iris hypoperfusion on fluorescein angiography. We have seen all these signs in a man in his early 20s undergoing transposition combined with botulinum toxin injection, so it is not entirely surprising to see a more profound effect in the occasional 74-year-old woman with known hypertension. Happily, anything other than the worst cases References 1. Keech RV, Morris RJ, Ruben JB, Scott WE. Anterior segment ischemia following vertical muscle transposition and botulinum toxin injection . Arch Ophthalmol . 1990;108:176.Crossref 2. Hayreh SS, Scott WE. Fluorescein iris angiography, II: disturbances in iris circulation following strabismus operation on the various recti . Arch Ophthalmol . 1978;96:1390-1400.Crossref 3. Virdi PS, Hayreh SS. Anterior segment ischaemia after recession of various recti: an experimental study . Ophthalmology . 1987;94:1258-1271.Crossref 4. Olver JM, Lee JP. The effects of strabismus surgery on anterior segment circulation . Eye . 1989;3:318-326.Crossref 5. Fitzsimmons R, Lee JP, Elston JS. Treatment of sixth nerve palsy in adults with combined botulinum chemo denervation and surgery . Ophthalmology . 1988;95:1535-1542.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Ophthalmology American Medical Association

Anterior Segment Ischemia Following Vertical Muscle Transposition and Botulinum Toxin Injection

Archives of Ophthalmology , Volume 109 (2) – Feb 1, 1991

Anterior Segment Ischemia Following Vertical Muscle Transposition and Botulinum Toxin Injection

Abstract

Abstract To the Editor. —We read with interest the case report by Keech et al1 in the February 1990 issue of the Archives.This interesting report raises a number of matters that we would like to address. First, many authors, including Hayreh and Scott,2 Virdi and Hayreh,3 and us,4 have pointed out that the contribution of the anterior ciliary vessels of the vertical recti is variable and may be extensive. Under certain circumstances disinsertion of both vertical recti may be capable of...
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Publisher
American Medical Association
Copyright
Copyright © 1991 American Medical Association. All Rights Reserved.
ISSN
0003-9950
eISSN
1538-3687
DOI
10.1001/archopht.1991.01080020020006
Publisher site
See Article on Publisher Site

Abstract

Abstract To the Editor. —We read with interest the case report by Keech et al1 in the February 1990 issue of the Archives.This interesting report raises a number of matters that we would like to address. First, many authors, including Hayreh and Scott,2 Virdi and Hayreh,3 and us,4 have pointed out that the contribution of the anterior ciliary vessels of the vertical recti is variable and may be extensive. Under certain circumstances disinsertion of both vertical recti may be capable of causing mild anterior segment ischemia, ie, postoperative anterior chamber activity, sphincter abnormalities, and iris hypoperfusion on fluorescein angiography. We have seen all these signs in a man in his early 20s undergoing transposition combined with botulinum toxin injection, so it is not entirely surprising to see a more profound effect in the occasional 74-year-old woman with known hypertension. Happily, anything other than the worst cases References 1. Keech RV, Morris RJ, Ruben JB, Scott WE. Anterior segment ischemia following vertical muscle transposition and botulinum toxin injection . Arch Ophthalmol . 1990;108:176.Crossref 2. Hayreh SS, Scott WE. Fluorescein iris angiography, II: disturbances in iris circulation following strabismus operation on the various recti . Arch Ophthalmol . 1978;96:1390-1400.Crossref 3. Virdi PS, Hayreh SS. Anterior segment ischaemia after recession of various recti: an experimental study . Ophthalmology . 1987;94:1258-1271.Crossref 4. Olver JM, Lee JP. The effects of strabismus surgery on anterior segment circulation . Eye . 1989;3:318-326.Crossref 5. Fitzsimmons R, Lee JP, Elston JS. Treatment of sixth nerve palsy in adults with combined botulinum chemo denervation and surgery . Ophthalmology . 1988;95:1535-1542.Crossref

Journal

Archives of OphthalmologyAmerican Medical Association

Published: Feb 1, 1991

References