Accommodation changes after strabismus surgery due to anterior ciliary vessel disruption

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Accommodation changes after strabismus surgery due to anterior ciliary vessel disruption Renyi Xie 1,2,3 & Yan Wang 1,4

&

Meihua Pan 2,3 & Mei Yang 2,3

Received: 7 January 2020 / Revised: 8 August 2020 / Accepted: 19 August 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020

Abstract Purpose To evaluate monocular accommodation changes after strabismus surgery with and without anterior ciliary vessel preservation. Methods Sixty patients with horizontal concomitant strabismus who were scheduled to undergo monocular strabismus surgeries were randomly divided into two groups: A (without anterior ciliary vessel preservation) and B (with anterior ciliary vessel preservation). Group A was further divided into groups A1 (surgical eyes without anterior ciliary vessel preservation) and A2 (corresponding nonsurgical eyes). Group B was further divided into groups B1 (surgical eyes with anterior ciliary vessel preservation) and B2 (corresponding nonsurgical eyes). Monocular accommodative amplitude (AA) and accommodative facility (AF) were evaluated before and 1 day after the surgery to assess accommodation. Results In groups A2, B1, and B2, the AA and AF values showed no significant difference preoperatively or postoperatively. However, compared with preoperative values, both the postoperative AA and AF values were significantly reduced in group A1. Conclusion Strabismus surgery without anterior ciliary vessel preservation reduces monocular accommodation, whereas strabismus surgery with anterior ciliary vessel preservation protects accommodation. Keywords Anterior ciliary vessels preservation . Accommodative amplitude . Accommodative facility . Strabismus

Introduction The anterior ciliary vessels (ACVs) along the rectus muscles supply approximately 80% of the blood flow to the anterior segment, including the episcleral limbal plexus, intramuscular circulation within the ciliary body, and the major arterial circle in the iris root [1, 2]. These accompanying ACVs are disrupted simultaneously with concomitant disinsertion of the rectus muscles from the sclera during strabismus surgery, leading to a decrease in blood flow to the anterior segment,

* Yan Wang [email protected] 1

Clinical College of Ophthalmology, Tianjin Medical University, Tianjin, China

2

Xiamen Eye Centre of Xiamen University, Xiamen, China

3

Eye Institute of Xiamen University, Xiamen, China

4

Tianjin Eye Institute, Tianjin Key Laboratory of Ophthalmology and Visual Science, Tianjin Eye Hospital, No 4. Gansu Road, He-ping District, Tianjin 300020, China

including the ciliary body. When more than two rectus muscles are involved, anterior segment ischemia (ASI), a potentially serious complication of full-tendon tenotomy may result [3, 4]. To reduce the risk of ASI, ACV preservation has been practiced in surgeries involving three or four rectus muscles or in patients with thyroid dysfunction or other medical conditions [5–7]. However, emerging studies have shown that even without ASI, resection of one rectus muscle or tw