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 ≤1 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.
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