Initial postoperative deviation as a predictor of long-term outcome after surgery for intermittent exotropia

To determine the relationship between initial postoperative deviation and long-term results after surgery for intermittent exotropia.

A nonrandomized, retrospective case series. The records of patients who underwent surgery for intermittent exotropia between 2002 and 2006 and had 2 or more years of follow-up were evaluated. Distance alignment at postoperative week 1 was used to predict long-term surgical outcomes. A successful outcome was defined as no recurrence of exodeviation (exotropia/phoria >15(Δ)) at last follow-up.

A total of 81 patients with mean age of 7.2 years at surgery (range, 1.3-16.9) were included. Bilateral lateral rectus recession was performed in 24 patients, unilateral recession and resection in 48, and unilateral lateral rectus recession in 9. At postoperative week 1, 41 patients had orthophoria or undercorrection (0(Δ)-18(Δ) exotropia/phoria; Group A), 28 had esotropia/phoria ≤10(Δ) (Group B), and 12 had esotropia/phoria >10(Δ) (Group C) at distance. At 2 years after surgery, 12 patients (29%) in Group A, 3 patients (11%) in Group B, and none (0%) in Group C had recurrent exotropia. The recurrence rates within 2 years of surgery significantly differed between groups (P = 0.03). The long-term recurrence rates did not significantly differ in the 3 groups after a mean of 51 ± 23 months' follow-up.

Although initial overcorrection after intermittent exotropia surgery may be associated with lower probability of recurrence within 2 years after surgery, it cannot predict long-term motor outcomes.