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Abstract
<p class="first" id="d9080105e299">This case series study analyzes the use of iris
optic coherence tomography angiography
(OCT-A) for patients undergoing strabismus surgery at risk for anterior segment ischemia.
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<h5 class="section-title" id="d9080105e305">Question</h5>
<p id="d9080105e307">Is optical coherence tomography angiography useful in patients
undergoing strabismus
surgery to determine whether anterior segment ischemia is present?
</p>
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<h5 class="section-title" id="d9080105e310">Findings</h5>
<p id="d9080105e312">In this case series study of 9 participants, the mean vessel
density for all quadrants
had a relatively small decrease from preoperative to postoperative. Optical coherence
tomography angiography detected filling defects in the quadrant adjacent to the operated
muscle in 1 patient.
</p>
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<h5 class="section-title" id="d9080105e315">Meaning</h5>
<p id="d9080105e317">The clinical relevance of these findings is unknown, and given
the small sample size,
further research to determine its use in clinical practice seems warranted.
</p>
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<h5 class="section-title" id="d9080105e321">Importance</h5>
<p id="d9080105e323">Anterior segment ischemia (ASI) is a rare but potentially serious
complication of
strabismus surgery. Indocyanine green angiography and fluorescein angiography have
been used to reveal iris-filling defects for clinicians considering a patient’s risk
of ASI. However, both are limited by invasive and time-consuming nature and potential
adverse effects. Recently, optic coherence tomography angiography (OCT-A) has been
introduced and used to image iris vasculature in individuals without abnormalities.
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<h5 class="section-title" id="d9080105e326">Objective</h5>
<p id="d9080105e328">To determine the use of iris OCT-A for patients undergoing strabismus
surgery and
who are at risk for ASI.
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<h5 class="section-title" id="d9080105e331">Design, Setting, and Participants</h5>
<p id="d9080105e333">This prospective case series study took place in an academic
center. Adults undergoing
strabismus surgery on at least 1 vertical muscle were prospectively recruited. The
study took place from June to November 2017, and analysis began in January 2018.
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<h5 class="section-title" id="d9080105e336">Interventions</h5>
<p id="d9080105e338">Indocyanine green angiography and OCT-A of the iris preoperatively
and 1 day postoperatively.</p>
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<h5 class="section-title" id="d9080105e341">Main Outcomes and Measures</h5>
<p id="d9080105e343">A masked examiner evaluated all images and determined whether
any filling defects
were present qualitatively (lack of perfusion) and quantitatively (for OCT-A using
internal software to calculate vessel density).
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<h5 class="section-title" id="d9080105e346">Results</h5>
<p id="d9080105e348">Ten eyes of 9 individuals (mean [SD] age, 63 [11] years) were
included. Two individuals
(22.2%) identified as Hispanic, and 7 (77.8%) identified as white. There were 6 women
(66.7%). The mean preoperative vessel density (percentage of the area occupied by
vessels) averaged for all quadrants decreased from 57% preoperatively to 55% postoperatively
(mean difference, 2%; 95% CI, 0.4%-4.2%;
<i>P</i> = .05). When comparing quadrants adjacent to operated muscles, the mean vessel
density
decreased from 56% to 53% (mean difference, 2.6%; 95% CI, 0.17%-4.8%;
<i>P</i> = .02). In addition, OCT-A detected vascular filling defects in the quadrant
adjacent
to the operated muscle on the patients in whom they were present (n = 1, inferior
rectus recession).
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<h5 class="section-title" id="d9080105e357">Conclusions and Relevance</h5>
<p id="d9080105e359">In this preliminary study, OCT-A determined iris vessel filling
defects when present.
In addition, OCT-A gives qualitative vessel density values that can be compared preoperatively
and postoperatively although the clinical relevance of small differences is not known.
While only 10 eyes were evaluated, and as such generalizability of these findings
cannot be determined, the results suggest that OCT-A may be a useful tool in the evaluation
of patients undergoing strabismus surgery to determine whether a patient is at risk
to develop ASI.
</p>
</div>
Plication is an alternative tightening procedure to resection. In monkeys, plication has been shown to preserve anterior segment circulation compared with full-tendon tenotomy, but this is unconfirmed in humans.