Conventional, full-tendon, rectus muscle surgery disrupts the anterior ciliary vessels. This may lead to anterior segment ischemia when the number of interrupted vessels is sufficient to significantly compromise anterior segment blood flow. Clinical observations and histologic studies provide new anatomic information concerning the course of the anterior ciliary vessels in the sub-Tenon's region. These studies demonstrate the feasibility of dissection and preservation of the anterior ciliary vessels during rectus muscle surgery. Dissection and preservation of 35 clinically apparent anterior ciliary vessel groups were attempted on 15 rectus muscles during strabismus surgery. The unplanned vessel destruction rate was 9.5%. Procedures included 12 recessions, 1 resection, and 2 full-tendon transpositions. The possible role of this procedure in the prevention of anterior segment ischemia is discussed.
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