A Clinical Study Of Routine Strabismus Surgery With Anterior Ciliary Vessels Preservation

Purpose:To evaluate monocular accommodation and anterior chamber flare changes and compare the short-term and long-term effects after strabismus surgery with and without anterior ciliary vessel(ACVs)preservation.Methods:In part 1: 60 patients with horizontal concomitant strabismus who were scheduled to undergo monocular strabismus surgeries were randomly divided into two groups: A(without ACVs preservation)and B(with ACVs preservation).Group A was further divided into groups A1(surgical eyes without ACVs preservation)and A2(corresponding nonsurgical eyes).Group B was further divided into groups B1(surgical eyes with ACVs preservation)and B2(corresponding nonsurgical eyes).Monocular accommodative amplitude(AA)and accommodative facility(AF),anteriorchamber flare(FL)values were evaluated 1 day preoperation and 1 day,1week,1 month,3 months postoperation to assess accommodation and the blood-aqueous barrier function.In part 2: 300 patients with horizontal concomitant strabismus who were to undergo strabismus surgery were randomly divided into two groups: group A(without ACVs preservation)and group B(with ACVs preservation).Group A was further divided into A1(exotropia without ACVs preservation)and A2(esotropia without ACVs preservation).Group B was further divided into B1(exotropia with ACVs preservation)and B2(esotropia with ACVs preservation).The correction rates of the four groups were compared 1 day preoperation and 1 day,1 week,1 month,3months and 6 months postoperation.Results:In part 1: The values of AA,AF and FL showed no significant difference in group A2,B1 and B2 at the preoperative and each time points postoperative.However,in group A1,the values of AA reduced 1 day and 1 week postoperative,and values of AF reduced 1 day,1 week and 1 month postoperative,The values of FL increased 1 day postoperative.In part 2:In group B,the success rate of ACVs preservation in lateral rectus was97.3%(179/184).the success rate of ACVs preservation in medial rectus was97.2%(137/141).In group A1,the correction rate was 80.6% 1 day postoperative.The highest correction rate reached 96.8% in the 1st month,and the correction rate decreased to 69.9% in the 6th month.In group A2,the correction rate was 93% on the1 st day postoperation,and remained stable at different time points.By the 6th month,the correction rate was 96.4%.In Group B1,the correction rate was 83.7% on the 1st day postoperation.The highest correction rate was 95.9% at 1 week and 1 month postoperation,and the correction rate decreased to 86.7% in the 6th month.In the group B2,the correction rate was 91.7% on the 1st day postoperation,97.9% in the1 st week,and 93.8% in the 6th month.Conclusions:1.Strabismus surgery without ACVs preservation reduces monocular accommodation and affected the blood-aqueous barrier function.whereas strabismus surgery with ACVs preservation protects accommodation and the blood-aqueous barrier.2.It reached a high success rate of anterior ciliary vessels preservation in microstrabismus surgery,and the correction rate can be improved in long term.