Göçmen Emine Seyhan, Atalay Yonca, Evren Kemer Özlem, Sarıkatipoğlu Hikmet Yavuz
Ankara Numune Training and Research Hospital, Ophthalmology Clinic, Ankara, Turkey.
Turk J Ophthalmol. 2017 Jan;47(1):47-51. doi: 10.4274/tjo.93824. Epub 2017 Jan 17.
A 46-year-old male patient was referred to our clinic with complaints of diplopia and esotropia in his right eye that developed after a car accident. The patient had right esotropia in primary position and abduction of the right eye was totally limited. Primary deviation was over 40 prism diopters at near and distance. The patient was diagnosed with sixth nerve palsy and 18 months after trauma, he underwent right medial rectus muscle recession. Ten months after the first operation, full-thickness tendon transposition of the superior and inferior rectus muscles (with Foster suture) was performed. On the first postoperative day, slit-lamp examination revealed corneal edema, 3+ cells in the anterior chamber and an irregular pupil. According to these findings, the diagnosis was anterior segment ischemia. Treatment with 0.1/5 mL topical dexamethasone drops (16 times/day), cyclopentolate hydrochloride drops (3 times/day) and 20 mg oral fluocortolone (3 times/day) was initiated. After 1 week of treatment, corneal edema regressed and the anterior chamber was clean. Topical and systemic steroid treatment was gradually discontinued. At postoperative 1 month, the patient was orthophoric and there were no pathologic symptoms besides the irregular pupil. Anterior segment ischemia is one of the most serious complications of strabismus surgery. Despite the fact that in most cases the only remaining sequel is an irregular pupil, serious circulation deficits could lead to phthisis bulbi. Clinical properties of anterior segment ischemia should be well recognized and in especially risky cases, preventative measures should be taken.
一名46岁男性患者因车祸后出现右眼复视和内斜视被转诊至我院门诊。患者在第一眼位时有右眼内斜视，右眼外展完全受限。近距和远距的原发性斜视超过40棱镜度。患者被诊断为第六神经麻痹，外伤18个月后，他接受了右眼内直肌后徙术。第一次手术后10个月，进行了上、下直肌全层肌腱转位术（采用福斯特缝合）。术后第一天，裂隙灯检查发现角膜水肿，前房有3+细胞，瞳孔不规则。根据这些发现，诊断为眼前段缺血。开始使用0.1/5毫升的局部地塞米松滴眼液（每天16次）、盐酸环喷托酯滴眼液（每天3次）和20毫克口服氟可龙（每天3次）进行治疗。治疗1周后，角膜水肿消退，前房清亮。局部和全身类固醇治疗逐渐停药。术后1个月，患者眼位正，除瞳孔不规则外无其他病理症状。眼前段缺血是斜视手术最严重的并发症之一。尽管在大多数情况下，唯一遗留的后遗症是瞳孔不规则，但严重的循环缺陷可能导致眼球痨。应充分认识眼前段缺血的临床特征，在特别危险的情况下，应采取预防措施。
