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To evaluate the retinal and choroidal microvasculature after one or two horizontal rectus muscle surgeries in strabismus patients using swept-source optical coherence tomography angiography (SS-OCTA). 30 eyes of 26 patients who underwent horizontal rectus muscle surgery were included in this study. Group A, A’ and Group B , B’ respectively consisted preoperative and postoperative measurements of patients who underwent one or two horizontal rectus muscle surgeries. We analyzed the vessel density (VD) of the superficial vascular complex (SVC), the deep vascular complex (DVC), the choriocapillary layer (CC), choroidal vascular index (CVI), choroidal thickness (T-Ch) and retinal nerve fiber layer thickness (T-RNFL) preoperatively, and one week postoperatively. Only in the nasal sector of the perifoveal zone, the VD in SVC demonstrated a significant increase in Group A’ ( p  = 0.027). There was a statistically significant difference in the VD changes of SVC between Group A and Group B ( p  = 0.043). The VD in DVC did not change significantly in the whole macular compared with the preoperative. Moreover, in both Group A’ and Group B’, the VD in CC showed a reduction in a single sector of the parafoveal area ( p  &lt; 0.05). Group A’ have increased CVI in the nasal sector of the perifoveal region ( p  = 0.008). In addition, the T-Ch increase in the perifoveal region was more significant in Group B’ than in Group A’ ( p  &lt; 0.05). Group A’ showed statistically significant decreases in T-RNFL in the foveal and parafoveal regions ( p  &lt; 0.05). This study revealed that the increase in choroidal thickness was more significant after two rectus muscle surgery. In addition, there were microvascular changes in sectional macular regions after strabismus surgery. OCTA is an excellent way to study the impact of strabismus surgery on the macular structure and blood flow.

Changes in retinal and choroidal blood flow after one or two horizontal rectus muscle surgeries by optical coherence tomography angiography