Background To explore the retinal microvasculature in large-angle concomitant exotropia patients with abnormal binocular vision using optical coherence tomography angiography (OCTA) analysis. Methods OCTA images of 52 healthy and 100 strabismic eyes were analyzed to quantify the retinal thickness (RT), superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ). Paired t-tests were performed to compare differences between the two groups, the dominant eye and the deviated eye in the exotropia group, respectively. A p-value < 0.01 was considered significant. Results The mean angle of deviation was 79.38 [± 25.64] (prism diopters, PD). There were significant differences in the DCP in deviated eyes between the exotropia group and the control group (fovea: p = 0.007; temporal: p = 0.014; nasal: p = 0.028; inferior: p = 0.013). The temporal SCP in the exotropia group was significantly higher than in the control group in deviated eyes (p = 0.020). No significant difference was found between dominant eyes and strabismic eyes (p > 0.01). Conclusions The study showed that OCTA revealed subnormal DCP in patients with large-angle exotropia and abnormal binocularity which may be related to retinal suppression. Changes in the macular microvasculature may provide valuable insights into the development of strabismus. Further studies are needed to determine the clinical relevance of this finding. Trial registration This trial is registered as ChiCTR2100052577 at www.Chictr.org.cn.

Background: To explore the retinal microvasculature in large angle concomitant exotropia patients with abnormal binocular vision using quantitative optical coherence tomography angiography (OCTA) analysis. Methods: OCTA images of 52 healthy and 100 strabismic eyes were analyzed to quantify the retinal thickness (RT), superficial capillary plexus (SCP), deep capillary plexus (DCP), and foveal avascular zone (FAZ). Paired t-tests were performed comparing differences in the two groups, dominant and deviated eyes in exotropia group, respectively. Results: The mean angle of deviation at the distance was 79.38 [± 25.64] (prism diopters, PD). The temporal SCP in exotropia group was significantly higher than that of control group in deviated eyes (p = 0.020). Nasal vessel density in exotropia group was lower than that of control group in the SCP in deviated eyes (p = 0.037). There were significantly differences in the DCP in deviated eyes between exotropia group and control group (Fovea: p = 0.007; Temporal: p = 0.014; Nasal: p = 0.028; Inferior: p = 0.013). Dominant eyes had significantly greater nasal RT and temporal SCP than deviated eyes (p = 0.023 and p = 0.043). Conclusions:The study found that OCTA reveals subnormal, superficial, and deep macular capillary density in large angle exotropia patients with abnormal binocularity and may be related to retinal suppression. Changes in macular microvasculature may offer valuable insights in the development of strabismus. Further studies are needed to determine the clinical relevance of this finding. Trial registration: This trial is registered as ChiCTR2100052577 at www.Chictr.org.cn .