Intermittent exotropia surgery: results in different age groups

To report the outcomes in patients undergoing surgical correction of intermittent exotropia and to compare the age at surgery to motor and sensory success.

This was a retrospective cohort study. The results of patients with intermittent exotropia treated with surgery over a 4-year period were reviewed. Patients were divided into two groups based on age at first surgery (<4 years vs. ≥4 years), and motor and sensory outcomes were compared between the two groups.

One hundred thirty-six patients were evaluated, with 67 and 51 patients undergoing surgery before and after the age of 4 years, respectively. The mean age at surgery was 6.8 ± 2.6 years. The reoperation rate for the patients who underwent surgery before 4 years of age was 48% versus 42% for the ones who underwent surgery after this age (p=0.93). Postoperative stereopsis showed an inverse linear association with age at surgery (p<0.001). For each month younger at the time of surgery, there was 0.69 s of arc worsening in the Titmus test. Conversely, when we separately analyzed the patients in whom the first postoperative alignment was esotropic vs. orthophoric/exotropic, we found no correlation between the immediate postoperative alignment in the first week and sensory outcome at the last visit.

When indicated, patients with intermittent exotropia can be operated upon safely under 4 years of age, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.