Anterior Segment Imaging With Optical Coherence Tomography In Strabismus Surgery: How Does The Eye Actually Heal?

We sought to present results of our study including anterior segment optical coherence tomography (AS-OCT) and axial length (AX, mm) in uncomplicated resection (Res) and recession (Rec) strabismus surgery for esotropia (ET) and exotropia (XT).

The application of optical coherence tomography (OCT) in ophthalmology is wide, however, AS-OCT is seldom used in planning strabismus surgery. A thinned sclera at the site of intraoperative muscle adhesion after Rec and a thickened sclera after Res 3-5 months after the procedure was earlier reported. However, the exact anterior segment structures' healing process has not been showed using AS-OCT in patients who have undergone surgery for strabismus.

: A single-center study was conducted in the Department of Ophthalmology of University Hospital Center Osijek in a city in Osijek, Croatia between November 2024 and June 2025. All patients were admitted for a two-day hospital stay because of strabismus surgery. Other visits were in outpatient settings.

AS-OCT is used for preoperative visualization and follow-up of ocular structures at one week; one, two and three months postoperatively. Scleral thickness at the tendon insertion (STI, µm) was measured for medial and lateral rectus muscle (MR and LR; respectively). Full thickness slice was measured at the MR insertion point (FTPM, µm) and LR insertion point (FTPL, µm) preoperatively and 3 months postoperatively. AX was measured using optical biometry.

29 patients were included in the study. The mean age of the participants was 15.9±11.3 years (6–59 yrs). XT was present in 21 patients, while 8 patients had ET. A linear mixed-effects model showed a significant increase in FTPM from baseline to 3 months (F(1,26.14)=34.82,p<.001), with a significant time×surgery interaction (F(1,26.14)=14.83,p<.001). Estimated marginal means indicated a large increase after Res (853→1084 µm;+231 µm) and a smaller increase after Rec (911→960 µm;+49 µm). A linear mixed-effects model showed a significant increase in FTPL from baseline to 3 months (F(1,25.53)=20.25,p<.001). Overall, FTPL increased by approximately 111 µm from baseline to 3 months. STI remained stable in Res and in Rec patients.

Increased slice thickness is probably caused by an increase in stromal thickness, especially on the medial side. There is a tendency of scleral thinning, prominent in one month postoperatively.