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February 1990

Anterior Segment Ischemia Following Vertical Muscle Transposition and Botulinum Toxin Injection

Author Affiliations

Iowa City, Iowa

Arch Ophthalmol. 1990;108(2):176. doi:10.1001/archopht.1990.01070040028016

Ischemia of the anterior segment of the eye is a well-known complication of extraocular muscle transposition procedures.1 Fitzsimmons et al2 and Rosenbaum et al3 recently described the use of botulinum toxin to the medial rectus muscle in combination with temporal transposition of the vertical recti for chronic sixth-nerve palsy. They suggested that this technique may reduce the risk of anterior segment ischemia. However, as the following case illustrates, anterior segment ischemia may still occur with this surgical procedure.

Report of Case.  —A 74-year-old woman, with a 10-year history of hypertension, developed a right sixth-nerve palsy following a motor vehicle accident. Ten weeks after the injury, she had a right face turn with a 50-diopter right esotropia in primary gaze with near and distance fixation and was unable to abduct the eye to the midline. Her visual acuity was reduced to 20/50 OD and 20/30 OS as a

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