Adjustable Procedure Research Articles

Evolutional development & design of an adjustable single gear tooth testing procedure for polymer gearing

Evolutional development & design of an adjustable single gear tooth testing procedure for polymer gearing

Model based view planning for the robot-guided automation of optical 3D digitization based on a variable mesh resolution processing approach

The digital 3D representation of manufactured parts plays a crucial role in the quality assurance of small, individualized lot sizes. Machine vision systems, such as optical 3D scanners, guided by an industrial robotic arm, allow for a contactless full digital reconstruction of surface geometries. In order to digitize the whole geometry, it is necessary to acquire 3D scans from multiple viewpoints with respect to the part, which in combination cover the entire surface. With efficiency in mind, this results in an optimization problem between a high surface area coverage and low measurement effort, referred to as the view planning problem. In the presented work, two popular viewpoint candidate generation methods are implemented: Firstly, a surface-based random sampling method, which generates viewpoints within a solution space, in which visibility of a given model surface can be expected. Secondly, a view sphere viewpoint generation approach, which is independent of the object geometry but avoids clustering by generating evenly spaced viewpoints on a sphere around the centre of the object. Using an adjustable remeshing procedure, a multi-stage approach is implemented by generating multiple meshes with different resolutions. Through this, the benefits of working on a coarse mesh, such as fast viewpoint candidate evaluation and selection, are combined with the level of detail of a fine mesh. It is found that it is possible to considerably reduce the mesh resolution while maintaining a reasonably high surface area coverage on a reference model. Applying the proposed procedure to the view planning for a state-of-the-art 3D fringe light projection scanner with highly sophisticated scanning capabilities, it is demonstrated that the view sphere approach is more suitable for this use-case due to the large measurement volumes of the 3D scanner. The frequently used random sampling approach requires an excessively higher computational effort to achieve similar results in comparison.

O076 Long term outcomes of “Christmas tree” banding for the treatment of dialysis access related steal syndrome: a thirteen-year experience with the technique

Abstract Introduction High flowrates in arterio-venous fistulas (AVF) and the associated distal arterial insufficiency can cause Dialysis-Access related Steal Syndrome (DASS). Various techniques including ligation, banding, and bypass with interval-ligation have been advocated to treat this difficult problem with varying success. We present the long-term outcomes following a novel banding technique. Methods 46 patients in this prospective cohort-study from 2008–2021 underwent an adjustable banding procedure using a PTFE patch shaped with one slit-end and saw-tooth edges (resulting in a ‘‘Christmas tree’’ pattern) to provide a ratchet mechanism to progressively constrict the draining vein. Real-time finger perfusion pressure monitoring allowed an optimal compromise between distal extremity and AVF perfusion. Comparisons between groups were measured and survival curves were obtained using the Kaplan-Meier method based on the log-rank test to calculate the thrombosis-free survival. Results 63%(n=29) presented with constant pain and 24%(n=11) presented with tissue loss due to steal syndrome. Post-intervention patency was 100%,97.7%,95%,86% and 72% at 30 days, 60 days, 180 days, 1 year and 3 years, respectively. Complete resolution of symptoms was achieved in 74%(n=34) of patients and 11%(n=5) reported partial response needing no further intervention. We also observed that pre-procedure finger pressures of 41mmHg or below was highly specific for “true” steal-syndrome and these patients were more likely to completely respond to banding (p=0.016). The overall mean thrombosis free survival was seen to be 1844±168 days. Conclusion This adjustable dynamic method of AVF banding demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss. Take-home message The described adjustable dynamic method of AVF banding under local anaesthesia demonstrates a sustained efficacy in patients with DASS in the long term with a very low risk of patency loss.

Deep Brain Stimulation of the Nucleus Accumbens in Severe Enduring Anorexia Nervosa: A Pilot Study.

IntroductionAnorexia nervosa (AN) is one of the most debilitating psychiatric disorders, becoming severe and enduring in a third of cases; with few effective treatments. Deep brain stimulation is a reversible, adjustable neurosurgical procedure that has been gaining ground in psychiatry as a treatment for depression and obsessive–compulsive disorder, yet few studies have investigated AN. Abnormal eating behavior and the compulsive pursuit of thinness in AN is, in part, a consequence of dysfunction in reward circuitry and the nucleus accumbens (NAcc) is central to reward processing.MethodsPhase 1 prospective open-label pilot study of seven individuals with severe enduring AN. Electrodes were implanted bilaterally into the NAcc with stimulation at the anterior limb of the internal capsule using rechargeable implantable pulse generators. The protocol of 15 months included 12 months of deep brain stimulation incorporating two consecutive, randomized blind on-off fortnights 9 months after stimulation onset. The primary objectives were to investigate safety and feasibility, together with changes in eating disorder psychopathology.ResultsFeasibility and safety was demonstrated with no serious adverse events due to deep brain stimulation. Three patients responded to treatment [defined as > 35% reduction in Eating Disorders Examination (EDE) score at 12 months] and four patients were non-responders. Responders had a statistically significant mean reduction in EDE scores (50.3% reduction; 95% CI 2.6–98.2%), Clinical Impairment Assessment (45.6% reduction; 95% CI 7.4–83.7%). Responders also had a statistically significant mean reduction in Hamilton Depression Scale, Hamilton Anxiety Scale and Snaith-Hamilton pleasure scale. There were no statistically significant changes in Body Mass Index, Yale-Brown-Cornell Eating Disorder Scale, Yale-Brown Obsessive–Compulsive Scale and World Health Organization Quality of Life Psychological subscale.ConclusionThis study provides some preliminary indication that deep brain stimulation to the NAcc. Might potentially improve some key features of enduring AN. In this small study, the three responders had comorbid obsessive-compulsive disorder which predated AN diagnosis. Future studies should aim to further elucidate predictors of outcome.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [Project ID 128658].

Torsional incomitance after asymmetrically adjusted Harada-Ito procedures for the simultaneous correction of vertical and torsional deviations in bilateral trochlear nerve palsy

Adjustable bilateral Harada-Ito procedures have been described, sometimes with asymmetric adjustment used to correct vertical misalignment when coexisting with torsional strabismus. We investigated the causes of significant postoperative torsional incomitance noted in some patients undergoing these procedures. The medical records of patients who underwent bilateral Harada-Ito procedures for bilateral trochlear nerve palsy between 1980 and 2018 were reviewed retrospectively. Cases with simultaneous operation on any other oblique or vertical rectus muscle were excluded. Surgical results, especially using Lancaster red-green (Lan R-G) plots, were correlated with the procedures performed. A total of 17 patients were included. At their last follow-up visit (mean, 12 months after surgery), 9 were diplopia free. Of the 8 with continuing diplopia, 2 had undercorrection and 1 had Brown syndrome. In 5 patients with continuing diplopia, there was relative intorsion of the eye movement paths in upgaze and relative extorsion of these paths in downgaze, a type of torsional incomitance. Asymmetric adjustment with tightening of one superior oblique tendon, and often loosening of the contralateral superior oblique tendon, had been performed in those 5 cases. Only 1 of the successful cases had the same type of asymmetric adjustment. There was a positive association between the severity of the preoperative Lan R-G pattern and postoperative diplopia. Asymmetric adjustment of bilateral Harada-Ito procedures when attempting to correct the coexisting vertical misalignment can cause significant torsional incomitance with incomplete correction of extorsion in downgaze and intorsion in upgaze. This pattern may result in postoperative diplopia that is surgically challenging to correct.

Evaluation of a Dry Method Using Erasers for Silver–Copper Alloy Tarnish Cleaning and Comparison with Traditional Methods

ABSTRACT Tarnishing is one of the most crucial issues in the conservation of silver alloy objects. This phenomenon is relevant in the field of cultural heritage artifacts: although the blackish patina protects to a degree against ulterior corrosion effects, it significantly affects the aesthetical features of the artwork. Several different approaches are utilized for cleaning tarnished silver–copper alloy surfaces, including mechanical, chemical, electrochemical methods. The use of lasers is also reported. In this paper a dry approach based on the use of erasers is proposed and compared with traditional methods. The different methods were applied on silver–copper alloy mockups which had been artificially tarnished. They were compared based on the degree of sulfide removal and damage to the silver surface. Diagnostic investigations showed that the use of erasers for silver cleaning resulted in fewer surface modifications compared to traditional mechanical methods with an effective tarnish removal. The proposed method could be broadly considered a low-cost, adjustable, and fast one-step cleaning procedure. Finally, two case studies of application of the technique are reported: cleaning of three Islamic artifacts decorated with silver alloy inlay and of the silver letters on the North Door of the Baptistery of Florence.

A Hydrophobic Tissue Clearing Method for Rat Brain Tissue.

Hydrophobic tissue clearing methods are easily adjustable, fast, and low-cost procedures that allows for the study of a molecule of interest in unaltered tissue samples. Traditional immunolabeling procedures require cutting the sample into thin sections, which restricts the ability to label and examine intact structures. However, if brain tissue can remain intact during processing, structures and circuits can remain intact for the analysis. Previously established clearing methods take significant time to completely clear the tissue, and the harsh chemicals can often damage sensitive antibodies. The iDISCO method quickly and completely clears tissue, is compatible with many antibodies, and requires no special lab equipment. This technique was initially validated for the use in mice tissue, but the current protocol adapts this method to image hemispheres of control and transgenic rat brains. In addition to this, the present protocol also makes several adjustments to preexisting protocol to provide clearer images with less background staining. Antibodies for Iba-1 and tyrosine hydroxylase were validated in the HIV-1 transgenic rat and in F344/N control rats using the present hydrophobic tissue clearing method. The brain is an interwoven network, where structures work together more often than separately of one another. Analyzing the brain as a whole system as opposed to a combination of individual pieces is the greatest benefit of this whole brain clearing method.

Management of Urinary Incontinence With Underactive Bladder: A Review.

Urinary incontinence is caused by storage function failure, while underactive bladder (UAB) is caused by a decline in detrusor contractility and voiding dysfunction. As the treatment mechanisms for incontinence and UAB are contrary to each other, it is difficult to treat both incontinence and UAB, and the patient’s quality of life can be further degraded. Conventional midurethral sling (MUS), such as transobturator tape or retropubic MUS, introduces a risk of postoperative voiding dysfunction in stress urinary incontinence with UAB. However, there have been several reports about the efficacy and safety of conventional MUS. Adjustable sling procedures, such as transobturator adjustable tape or the Remeex system, have better outcomes than conventional MUS because they control tension both during and after surgery. When voiding dysfunction occurs after incontinence treatment with UAB, voiding symptoms can be improved by various therapeutic modalities. Clean intermittent catheterization is recommended for patients with significant increased postvoid residual volumes or urinary retention. Although pharmacotherapy such as with alpha-blockers or parasympathomimetics can be considered for UAB, there is insufficient evidence of their effect on incontinence with UAB. Future therapies, such as stem cell therapy or gene therapy, may be used to treat incontinence with UAB. The possibility of management urgency urinary incontinence that related to detrusor hyperactivity with impaired contractility using sacral neuromodulation has been suggested. Further research is needed to establish evidence for the efficacy and safety of treatments for incontinence with UAB and improve patient quality of life.

Refractive Changes After Corneal Stromal Filler Injection for the Correction of Hyperopia.

To evaluate a new non-ablative and adjustable procedure for laser ablative refractive corneal surgery in hyperopia using the injection of a biocompatible liquid filler material into a stromal pocket. A total of 120 stromal pockets were created using a clinical femtosecond laser system in 96 rabbit corneoscleral discs and 24 whole globes. Pockets were cut at a depth of 120 or 250 µm below the epithelial surface. Hyaluronic acid was injected manually into the pocket. To determine the refractive changes, three-dimensional optical coherence tomography images and a specifically developed picture recognition Matlab (The Mathworks) routine were used. After injection, a steepening of the anterior and flattening of the posterior corneal surface was observed, which led to hyperopic correction. The two main factors determining the amount of correction were the pocket depth and the injected volume. After the pocket was homogeneously filled, an initial refractive increase was observed, followed by a linear relation between the injected volume and the refraction increase. This possible clinical protocol for controlled refraction correction of hyperopia suggests a potential readjustable clinical application. [J Refract Surg. 2020;36(6):406-414.].

Safety of adjustable gastric band conversion surgery: a systematic review and meta-analysis of the leak rate in 1- and 2-stage procedures.

Laparoscopic adjustable gastric banding has been a popular bariatric surgery in the United States since the early 2000s. Over the years, various long-term complications have prompted removal of these devices. To avoid subsequent weight gain, explanation of the gastric band is often followed by concomitant or staged conversion to another bariatric procedure. It is our goal to evaluate the relative leak rate in 1- versus 2-stage adjustable gastric band conversion surgery. Private teaching hospital, United States. A search was performed in the PubMed/MEDLINE and Cochrane Library databases to evaluate literature regarding adjustable gastric band conversion procedures. After identification of publications that directly compared 1- and 2-stage laparoscopic adjustable gastric banding conversions, the Newcastle-Ottawa Quality Assessment Scale was used to determine if they would be used in our meta-analysis. The risk ratio for leak in 1- versus 2-stage conversions was then calculated. Our search yielded 483 publications. Twenty-five publications qualified for inclusion. The overall calculated risk ratio for leak in 1- versus 2-stage conversions was .90 (confidence interval [CI] .51-1.61, P = .73). Eight publications were found that discussed conversion from laparoscopic adjustable gastric banding to Roux-en-Y gastric bypass. The risk ratio for 1- versus 2-stage conversions for this subgroup was .82 (CI .35-1.93, P = .65). Eight publications were found that evaluated conversion to sleeve gastrectomy. The risk ratio of leak for 1- versus 2-stage conversions for these patients was 1.61 (CI .55-4.72, P = .39). Based on the results of this meta-analysis, there does not appear to be a significant difference in the overall leak rate between 1- and 2-stage adjustable gastric band conversions. The findings of our subgroup analysis suggest that there may be a safety advantage for 1-stage procedures when converting to Roux-en-Y gastric bypass and 2-stage procedures when converting to sleevegastrectomy.

Detection of EEG Signal and De-Noising for Hypoglycemia detection by Brain Wave Sensor

Electroencephalography (EEG) signs have remained proven an identical adaptable apparatus for recognition of dissimilar types of Brain infections. Nevertheless through footage of these signs, EEG records gets soiled by different clatter signs produced through supply line interfering, base-line-wander, probe association, muscle-movement etc. Such sound signs misinform analysis of brain that is not anticipated. To circumvent such problematic elimination of the sound signals been develop crucial. Owing to development of data and information equipment tele-medicine and e-health have developed prevalent in emerging and urbanized republics. In the examination drudgery we partake verified three dissimilar categories of adjustable filtering procedures to associate the presentations for scheming EEG signal as of arbitrary and Gaussian-noise. The main idea of the work is to interface the human brain signals and machine in an easy and cheapest manner to find out the various abnormalities in him. The methodology is as follows, we took brain-wave senor for acquiring of data from the person, and this is standard device available in market. The senor is connected to the laptop or system with the help of Bluetooth and the signals are acquired. The acquired signal will be a noisy signal which is to be de-noised and filtered for further process of detection. Random and white-Gaussian-noise is added with EEG signal and Adaptive filter with three different algorithms have been tested to reduce the noise that is added during transmission through the telemedicine system. Further based on the sum, mean and standard deviation parameters the individual is been evaluated the condition is been predicted. After an experimental learning of teenagers with type-1-diabetes (T1D), accompanying with hypoglycemic incident night, centroid, alpha-frequency condensed meaningfully and the centroid theta-frequency augmented meaningfully. The complete data remained prearranged hooked on a preparation set and examination customary arbitrarily designated. By means of proposed methodology, which was resultant as of teaching set through maximum log indication, projected blood-glucose summaries created a noteworthy relationship in contradiction of measured standards in assessment set.

Lipid droplet quantification based on iterative image processing

Lipid droplets (LDs) are ubiquitous and highly dynamic subcellular organelles required for the storage of neutral lipids. LD number and size distribution are key parameters affected not only by nutrient supply but also by lipotoxic stress and metabolic regulation. Current methods for LD quantification lack general applicability and are either based on time consuming manual evaluation or show limitations if LDs are high in numbers or closely clustered. Here, we present an ImageJ-based approach for the detection and quantification of LDs stained by neutral lipid dyes in images acquired by conventional wide-field fluorescence microscopy. The method features an adjustable preprocessing procedure that resolves LD clusters. LD identification is based on their circular edges and central fluorescence intensity maxima. Adaptation to different cell types is mediated by a set of interactive parameters. Validation was done for three different cell lines using manual evaluation of LD numbers and volume measurement by 3D rendering of confocal datasets. In an application example, we show that overexpression of the acyl-CoA synthetase, FATP4/ACSVL5, in oleate-treated COS7 cells increased the size of LDs but not their number.

Spinal Cord Stimulation in Pregnant Patients: Current Perspectives of Indications, Complications, and Results in Pain Control: A Systematic Review.

Spinal cord stimulation (SCS) has been described as a valuable neuromodulator procedure in the management of chronic medically untreated neuropathic pain. Although the use of this technique has been published in many papers, a question still remains regarding its applicability in pregnant patients. The goal of this paper is to discuss the risks, complications, and results as well as the prognosis of SCS in pregnant patients. We performed a systematic review from 1967 to 2018 using the databases MEDLINE, LILACS, SciELO, PubMed, and BIREME, utilizing language as selection criteria. Eighteen studies that met our criteria were found and tabulated. SCS is a reversible and adjustable surgical procedure, which results in patients that demonstrated a significant effect in the reduction of pain intensity in pregnant patients. The etiologies most frequent were complex regional pain and failed back pain syndromes, which together represented 94% of analyzed cases. The technical complications most frequent were lead migration (3%, n = 1). Regarding the risks, the authors did not show significative factors among the categorical variables that can suggest a teratogenicity, while the maternal risks have been associated to the consequences of technical complications due to, among other factors, improvement of abdominal pressure during pregnancy and delivery. Finally, although there are not significative cohorts of pregnant patients, the procedure is still an effective surgical approach of neuropathic pain associated to lower rates of complications and significative improvement in the quality of life of patients during pregnancy.

A heuristic moment-based framework for optimization design under uncertainty

To search an optimal design under uncertainty, this study proposes an effective framework that integrates the moment-based reliability analysis into a heuristic optimization algorithm. Integration of an equivalent single-variable performance function is an ideal concept to calculate the failure probability. However, such integration is often not available and is alternatively computed using the first four moments and a generalized moment-based reliability index is established, in which the Gaussian–Hermite integration and dimension reduction are implemented to enhance the effectiveness. To overcome the limited applicable range of moment-based approach, an adjustable optimization procedure is proposed, in which different reliability methods are performed depending on results of the constraint assessments. In addition, the e level comparison is integrated into particle-swarm optimization to consider the constraint violation. Several literature studies are used to verify the accuracy of the proposed optimization framework including problems having linear, highly nonlinear, implicit probabilistic constraint functions with normal or non-normal variables and system-level reliability analysis. The effects of several parameters, such as the number of estimate point, the number of dimension, and the degree of uncertainty, are thoroughly investigated. Results indicating that tri-variate with seven points are able to provide a stable solution under a high degree of uncertainty.

Multi-Centre Micro-Costing of Roux-En-Y Gastric Bypass, Sleeve Gastrectomy and Adjustable Gastric Banding Procedures for the Treatment of Severe, Complex Obesity.

There is a growing interest in comparing the effectiveness and costs of alternative forms of bariatric surgery. We aimed to examine the per-patient, procedural costs of Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG) and adjustable gastric banding (AGB) in the United Kingdom. Multi-centre (two National Health Service; NHS and one private hospital) micro-costing, using a time-and-motion study. Prospective collection of surgery times, staff quantities, equipment, instruments and consumables for 12 patients (four RYGB, five SG, three AGB) from patients' first surgeon interaction on the day of surgery to departure from the theatre recovery area. Costs were attached to quantities and mean costs compared. Sensitivity and scenario analyses assessed the impact of varying surgery inputs and consideration of additional plausible factors respectively on total costs. Mean procedural costs were £5002 for RYGB, £4306 for SG and £2527 for AGB. Varying staff seniority or altering procedure times had small impacts on costs (± 4-6%). Reducing prices of consumables by 20% reduced costs by 10-13%. Accounting for differences in surgical technique by altering the number of staple reloads used impacted costs by ± 7-10%. Adjusted total costs from scenario analyses were similar to NHS tariffs for RYGB and SG (difference of £51 and -£119 respectively) but were much lower for AGB (difference of £1982). These detailed costs will allow for more precise reimbursement of bariatric surgery and support comprehensive assessments of cost-effectiveness. Additional work to investigate costs of post-surgical care, re-operations and life-long support received by patients following surgery is required.

New parameter adjustment with spinal cord stimulation for postherpetic neuralgia treatment: A case report and literature review

Abstract Posterpetic neuralgia (PHN), a common and often severe painful condition, is a kind of refractory neuropathic pain (NP). Although the clinical treatment of PHN including pregabalin, nerve block and pulsed radiofrequency have been devoted with adequate and reasonable efforts, a proportion of people with PHN fail to obtain pain relief. Spinal cord stimulation (SCS) represents an adjustable and nondestructive procedure that considered electrical stimulation as the key mechanism for NP relief and offers an alternative treatment for PHN. SCS parameters, including amplitude, pulse width and frequency, influence the nervous system and the delivery of stimulation charge. Newly proposed stimulation methods such as high-frequency SCS and burst SCS, may offer alternative treatment for NP. In this paper, we reported a case of major pain successfully treated with SCS by adjusting the stimulation parameter and the electrode position using new stimulation method. The patient suffered from severe persistent PHN in the right upper limb area. The temporary SCS electrode was placed in the dorsal root entry zone (DREZ) area with a standard generator. Initially, we programmed the parameters at 360 Hz, 140 μs, and 1.5 V. After multiple setting adjustments with inadequate pain relief, the patient was finally programmed at 40 Hz, 120 μs, and 0.5 V. This parameter setting provided optimal pain alleviation and increased the quality of the patient's life. The visual analogue scale and Hamilton anxiety scores were decreased significantly. These scores showed no significant change during the six-month follow-up. SCS combined with dorsal root entry zone at relatively high frequency and low voltage offers a new method to treat PHN patients.

Unwinding of cyclodeviation after an adjustable Harada-Ito procedure

Unwinding of cyclodeviation after an adjustable Harada-Ito procedure

Outcomes of Adjustable Gastric Band Procedure at King Hussein Medical Center

Outcomes of Adjustable Gastric Band Procedure at King Hussein Medical Center

Effectiveness of the Remeex system™ in Colombian women with recurrent stress urinary incontinence or intrinsic sphincter deficiency.

We report our experience with the Remeex system™ in women with recurrent stress urinary incontinence (SUI) or intrinsic sphincter deficiency (ISD). A multicenter retrospective study was conducted in women who underwent an adjustable sling procedure between 2011 and 2016. We used urodynamic studies (UDS) preoperatively and the International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF) and cough stress test (CST) pre- and postoperatively. Primary outcomes were subjective (no leakage reported by the patient) and objective (no leakage during CST) cure and improvement rates (reduction of ≥4 points in ICIQ-SF). Descriptive and inferential statistics were employed. A total of 50 patients were included. Mean age was 62 years (SD ± 11.35). Median follow-up was 19.5months [interquartile range (IQR) 12.95-41.38]. Urinary incontinence (UI) was described as moderate and severe by 8 (16%) and 42 (84%) patients, respectively, and 25 (50%) had stress-predominant mixed urinary incontinence (MUI). Objective and subjective cure rates were 90% and 48%, respectively, while 82% of patients achieved improvement. Impact of UI on quality of life (QoL) improved from 10 (IQR 9-10) to 2 (IQR 0-5) (p< 0.0001). Clavien-Dindo II complications occurred in 14 (28%) patients, and one (2%) had IIIa. Tape erosion occurred in one (2%) patient, and five (10%) required readjustments. Logistic regression identified MUI [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.02-10.89] and vaginal atrophy (OR 4.2, 95% CI 1.06-16.03) as predictors of low subjective cure rate. Adjustable slings represent a valuable and safe option in the management of recurrent SUI or ISD, with improvement in QoL. Results should be carefully interpreted due to our small sample and retrospective design.

Anterior segment ischemia: etiology, assessment, and management.

Anterior segment ischemia (ASI) is a potentially serious but rare complication of strabismus surgery. Among several risk factors, ASI occurs after strabismus surgery because of the nature of the anterior segment circulation. Disinsertion of rectus muscles leads to a decrease in the blood supply to the various anterior segment structures. We report a series of retrospective and prospective studies performed by our group focused on determining the risk of anterior segment ischemia following strabismus surgery, diagnosis, and modifications to surgical techniques to minimize the impact on anterior segment circulation. We found a significant decrease in postoperative anterior segment blood flow when operating vertical rectus muscles. Plication procedures preserve anterior segment circulation, and modifications to the technique allow the performance of adjustable sutures. Small adjustable selective procedures that spare the ciliary vessels have been demonstrated to be effective in patients with vertical and torsional diplopia. Ciliary sparing augmented adjustable transposition surgery decreases the risk of anterior segment ischemia while allowing management of potential post-operative alignment complications. Finally, ocular coherence tomography angiography is a valuable quantitative and qualitative technique to evaluate anterior segment ischemia. Strabismus surgeons should be aware of the risks of anterior segment ischemia when operating vertical rectus muscles. Modifications to standard surgical techniques allow surgeons to perform complex strabismus surgery in patients at risk for anterior segment ischemia.