Accuracy of Optical Coherence Tomography Measurements of Rectus Muscle Insertions in Adult Patients Undergoing Strabismus Surgery

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Rossetto, Julia D. [UNIFESP]
Cavuoto, Kara M.
Allemann, Norma [UNIFESP]
McKeown, Craig A.
Capo, Hilda
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PURPOSE: To assess the accuracy of anterior segment optical coherence tomography (AS-OCT) in measuring the distance of extraocular muscle (EOM) insertion to the limbus to improve preoperative assessment of adult patients undergoing strabismus surgery. DESIGN: Reliability analysis. METHODS: SETTING: An institutional practice. PATIENT POPULATION: Seventy-four adult patients scheduled for strabismus surgery on rectus muscles. OBSERVATION PROCEDURE: The distance between the EOM insertion and the limbus was measured preoperatively with AS-OCT. The value was compared with the intraoperative measurement obtained with calipers. Additional measurements included the limbus-anterior chamber angle distance with AS-OCT and the axial length with IOLMaster. MAIN OUTCOME MEASURE: Agreement between preoperative AS-OCT and intraoperative measurements. A difference of 51 mm was "clinically acceptable." RESULTS: A total of 144 muscles were analyzed. Thirty-one of 33 reoperated muscles were successfully imaged. AS-OCT measurements were within 1 mm of intraoperative measurements in 77% of all muscles. The accuracy was higher for muscles with no prior surgery (83%), as compared with reoperated muscles (58%). Although the accuracy decreased when comparing reoperations to primary surgeries for the medial (79% to 63%
P = .09
95% confidence interval [CI], -1.38 to 0.11) and the lateral rectus (81% to 49%
P = .11
95% CI, -2.06 to 0.22), the difference was not significant. No correlation between limbus-anterior chamber angle distance and axial length was established. CONCLUSIONS: AS-OCT is valuable in identifying EOM insertions in primary strabismus surgeries, but the accuracy decreases in reoperations. (C) 2017 Elsevier Inc. All rights reserved.
American Journal Of Ophthalmology. New York, v. 176, p. 236-243, 2017.