Our Summary

This research paper talks about a rare case where a 30-year-old transgender woman, who has been taking estrogen for a long time, developed a serious eye condition known as anterior segment ischemia (ASI) after undergoing a certain type of eye surgery, called strabismus surgery. This condition, which causes reduced blood flow to the front part of the eye, usually occurs in older patients or those who have had surgery on three or more muscles in the eye, so it’s unusual to see in a young patient who only had surgery on two muscles in the eye. Unfortunately, the usual treatments for this condition, like eye drops, oral steroids, and injections, did not work for her. However, after undergoing another type of surgery a year later, her eye pressure and condition improved.

FAQs

  1. What are the known risk factors for anterior segment ischemia following strabismus surgery?
  2. Is anterior segment ischemia common in young patients after strabismus surgery?
  3. How was the case of severe anterior segment ischemia in a young patient treated and did the treatment improve the condition?

Doctor’s Tip

One helpful tip a doctor might tell a patient about strabismus surgery is to follow post-operative care instructions carefully to reduce the risk of complications such as anterior segment ischemia. This may include avoiding strenuous activities, keeping the eyes clean and protected, and attending follow-up appointments as scheduled. It’s important to communicate any concerns or changes in vision to your doctor promptly.

Suitable For

Patients who are typically recommended strabismus surgery are those who have misaligned eyes, which can cause double vision, amblyopia (lazy eye), or other visual disturbances. These patients may have conditions such as strabismus (crossed eyes or misaligned eyes), amblyopia, or other eye muscle disorders. They may have tried other treatments such as glasses, vision therapy, or patching, but have not seen significant improvement in their eye alignment. In some cases, patients with certain risk factors such as older age, vasculopathy, or the need for multiple muscle surgeries may be at higher risk for complications such as anterior segment ischemia, and their suitability for surgery may need to be carefully evaluated.

Timeline

Before strabismus surgery:

  1. Patient undergoes a comprehensive eye examination to determine the extent of the strabismus and the best course of treatment.
  2. Patient discusses the risks and benefits of surgery with their ophthalmologist.
  3. Pre-operative testing may be performed to assess the patient’s overall health and eye health.

After strabismus surgery:

  1. Immediately following surgery, the patient may experience some discomfort, redness, and swelling in the eye.
  2. The patient will be prescribed eye drops to prevent infection and promote healing.
  3. Follow-up appointments will be scheduled to monitor the healing process and assess the alignment of the eyes.
  4. In some cases, the patient may experience double vision or blurry vision as the eyes adjust to the new alignment.
  5. Over time, the eyes should gradually align and the patient should experience improved vision and depth perception.
  6. In rare cases, complications such as anterior segment ischemia may occur, requiring additional treatment and monitoring.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with strabismus surgery, particularly in my specific case?
  2. How experienced are you in performing strabismus surgery?
  3. What is the success rate for strabismus surgery, and what outcomes can I expect?
  4. Will I need to undergo any additional procedures or treatments before or after the surgery?
  5. How long is the recovery period after strabismus surgery, and what can I do to promote healing?
  6. Will I need to wear an eye patch or use eye drops following the surgery?
  7. How soon after the surgery can I resume my normal activities, such as driving or working?
  8. Are there any long-term effects or considerations I should be aware of after undergoing strabismus surgery?
  9. Will I need to follow up with you or another healthcare provider after the surgery, and if so, how often?
  10. Are there any specific precautions or lifestyle changes I should make to ensure the best possible outcome from the surgery?

Reference

Authors: Al-Lozi A, Koo EB, Lambert SR, Levin MH, Velez FG, Do DV, Shue A. Journal: J AAPOS. 2023 Aug;27(4):233-236. doi: 10.1016/j.jaapos.2023.05.004. Epub 2023 Jun 23. PMID: 37355012