Departement of Ophthalmology, Lund University Faculty of Medicine, Lund, Sweden.
Departement of Ophthalmology, Lund University Faculty of Medicine, Lund, Sweden
Br J Ophthalmol. 2024 Aug 22;108(9):1328-1332. doi: 10.1136/bjo-2023-324468.
BACKGROUND/AIMS: Anterior segment ischaemia (ASI) is a rare but serious complication of strabismus surgery, which may be caused by damage to the anterior ciliary arteries that run along the rectus muscles. To avoid ASI, clinical praxis is to operate on a maximum of two rectus muscles at a time. The aim of this study was to perform a detailed study of the contribution of the four ocular rectus muscles to the perfusion of the anterior segment using laser speckle contrast imaging (LSCI).
The four rectus muscles were successively detached during enucleation in nine patients with suspected uveal melanoma. Perfusion of the anterior segment was monitored with LSCI during the detachment of each of the rectus muscles, and after the ophthalmic artery had been severed.
Perfusion of the anterior segment, measured in the paralimbal tissue, decreased gradually as the four rectus muscles were detached, showing a decrease to 98% when the first (lateral rectus) muscle was detached, to 88% when the second (medial rectus), and 69% when the third (inferior rectus) muscles were detached. The decrease was more pronounced and statistically significant when the fourth (superior rectus) muscle was detached (to 28%, p=0.0102).
LSCI is a valuable perfusion monitoring tool, as it has the capability to visualise the gradual decrease in anterior segment perfusion as the rectus muscles are successively detached. Further studies are needed to determine how many rectus muscles can be safely detached during strabismus surgery without risking ASI.
背景/目的：前段缺血（ASI）是斜视手术罕见但严重的并发症，可能是由于沿直肌走行的睫状前动脉损伤所致。为避免 ASI，临床实践是一次最多同时操作两条直肌。本研究旨在使用激光散斑对比成像（LSCI）对四条眼外直肌对前段灌注的贡献进行详细研究。
在 9 例疑似葡萄膜黑色素瘤的患者中，在眼球摘除过程中依次分离四条直肌。在每条直肌分离过程中以及切断眼动脉后，使用 LSCI 监测前段的灌注情况。
在旁角膜组织中测量的前段灌注随着四条直肌的分离逐渐减少，当第一条（外直肌）肌肉分离时减少到 98%，当第二条（内直肌）和第三条（下直肌）肌肉分离时减少到 88%，当第三条（下直肌）肌肉分离时减少到 69%。当第四条（上直肌）肌肉分离时，减少更为明显且具有统计学意义（减少到 28%，p=0.0102）。
LSCI 是一种有价值的灌注监测工具，因为它能够可视化直肌依次分离时前段灌注的逐渐减少。需要进一步研究确定在斜视手术中可以安全分离多少条直肌而不会有发生 ASI 的风险。
