One aspect of muscle surgery which has not been completely explored is the number of muscles which can be attacked during one operation without producing damage to the eye. The purpose of this report is to review the literature on this subject; to report six cases in which the anterior segments of the eyes apparently were damaged as a result of removal of three or four rectus muscles at one procedure; and to present experimental evidence that the damage is caused by interference with the anterior ciliary circulation.
The textbooks of ophthalmology are particularly lacking in defining the extent of muscle surgery which may safely be performed without producing damage to the globe. Lindner1 (1943) advised against disinsertion of more than two muscles at any one time during retinal detachment surgery but did not state the consequences of disinsertion of a greater number. Leinfelder and Black2 (1941) in
GIRARD LJ, BELTRANENA F. Early and Late Complications of Extensive Muscle Surgery. Arch Ophthalmol. 1960;64(4):576-584. doi:10.1001/archopht.1960.01840010578016