Pre-, Intra-, and Post-Operative Evaluation of Extraocular Muscle Insertions Using Optical Coherence Tomography: A Comparison of Four Devices

Abstract

OCT (optical coherence tomography) is widely used in ophthalmology and pediatric ophthalmology, but limited research has been done on the use of OCT in strabismus. This study investigates the use of different OCT machines to image rectus muscle insertions pre-, intra-, and post-operatively in pediatric strabismus patients. The OCT machines used in the study were a Bioptigen (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA+OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss Rescan 700 (Carl Zeiss, Oberkochen, Germany). Measurements from the machines were compared with the caliper distance measured during the strabismus surgery before disinsertion or after reattachment. The OCT machines had moderate (Bioptigen: 0.62) to good intraclass correlation coefficients (Rescan: 0.83, Spectralis: 0.85, Visante: 0.88) with intra-operative measurements. To our knowledge, this is the first study to use an operating microscope with integrated intra-operative OCT to image rectus muscle insertions. OCT is a useful tool in strabismus surgical patients in the pre-, intra-, and post-operative settings, particularly in patients who have had previous surgery, when the muscle insertion is unknown. The ability to accurately image rectus muscle insertions has significant implications for the management of strabismus patients.

What Is the Impact of Intraoperative Microscope-Integrated OCT in Ophthalmic Surgery? Relevant Applications and Outcomes. A Systematic Review

“…Thirty-one articles were excluded: 19 were not written in English, 9 were review papers, and 3 were ex vivo studies. After full-text evaluation, 82 studies discussing the use of MI-OCT in ophthalmology were included [ 13 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , ...…”

“…MI-OCT can also play a role in strabismus surgery, in particular, in identifying rectus muscle insertion—which is usually hard to locate in patients who have had previous surgery—and confirming scleral suture passage [ 58 ]. Pihlbald et al compared extraocular muscle (EOM) measurements obtained with different OCT devices with calliper distance measured during strabismus surgery in 19 paediatric patients [ 59 ]. In particular, the OCT devices used were Bioptigen (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA + OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss RESCAN 700.…”

“…In particular, the OCT devices used were Bioptigen (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA + OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss RESCAN 700. All of them could accurately localize EOM insertion; however, MI-OCT (Zeiss RESCAN 700) succeeded in many cases and provided real-time information during surgery [ 59 ].…”

Accuracy of anterior segment optical coherence tomography for pre-operative localization of insertions of extraocular recti muscles

“…The study done by Rosetto 12 also included reproduction of OCT readings by a second person. The study conducted by Pihlblad et al 26 in 2019 included pre, intra and postoperative muscle insertion measurements. The different OCT machines used were Bioptigen, Inc. (Leica Microsystems Inc., Buffalo Grove, IL, USA), Spectralis HRA+OCT with Anterior Segment Module (Heidelberg Engineering, Heidelberg, Germany), Visante (Carl Zeiss, Oberkochen, Germany), and Zeiss Rescan 700 (Carl Zeiss, Oberkochen, Germany).…”

Shape analysis of rectus extraocular muscles with age and axial length using anterior segment optical coherence tomography

“…Recent advances in anterior segment optical coherence tomography (AS-OCT) have made it possible to visualize not only the cornea, anterior chamber, and iris but also the extraocular muscles (EOMs) [1][2][3][4][5][6][7][8][9]. However, these reports only involved the evaluation of tomographic images of the EOMs, and most of them were related to muscle insertion.…”