Abstract
Purpose :
Anterior ischemic syndrome (AIS) is a rare complication of strabismus surgery. It usually manifests with blurred vision, lid and corneal edema, anterior segment cells, and hypotony. Advances in ultrasound biomicroscopy enable high-quality visualization of the anterior segment as well as of the ciliary body and anterior choroid. This is the first description of UBM findings in AIS.
Methods :
We report the clinical data, fluorescein angiography, B-scan ultrasound (US) and UBM findings of a 56-year-old woman who presented with AIS 3 days after undergoing strabismus surgery. The US B-scans and UBM examinations were performed with the Aviso S instrument (Quantel Medical, Clermont-Ferrand, France) at 10 and 50 MHz, respectively.
Results :
The patient presented with decreased vision and severe pain in the operated eye 3 days after undergoing a Hummelsheim procedure and 1 month after medial rectus recession. Visual acuity was counting fingers only. She had severe corneal edema involving all layers of the cornea, a shallow anterior chamber with no inflammatory reaction, and a mild nuclear cataract. Ocular US disclosed mild thickening of the eyeball, and UBM demonstrated thickening of the ciliary body and substantial choroidal effusion causing shallowing of the anterior chamber. Iris fluorescein angiography showed delayed filling of the iritic vessels, without areas of ischemia. The patient was treated with oral and topical steroids and cycloplegic drops.
Three weeks later, her visual acuity improved to 20/50, the corneal edema resolved, and the anterior chamber was deep. UBM depicted normal anterior chamber depth, a normal ciliary body, and no choroidal effusion.
Conclusions :
This is a rare case of severe post-surgical AIS involving the entire anterior segment. UBM demonstrated ciliary body edema and choroidal effusion with secondary anterior chamber shallowing. Anterior segment imaging by UBM contributed to the determination of the pathophysiology of AIS and enabled a documented follow-up of the resolution of the inflammatory process.
:
This is a 2020 ARVO Annual Meeting abstract.