The clinical effect of surgical timing in infantile exotropia

To review the association of postoperative ocular alignment, sensory outcomes, and need for reoperation after surgical management of infantile exotropia.

The clinical records of patients who presented with constant infantile exotropia of >25^Δ and subsequently underwent strabismus surgery at a single center from 2004 to 2014 were reviewed retrospectively. Postoperative binocular sensory status was assessed using Worth 4-Dot and Titmus stereoacuity tests. Patients with postoperative exotropia of >10^Δ or esotropia of >5^Δ were advised to undergo additional surgery.

A total of 49 cases were included (28 boys; age at diagnosis, 1-12 months). The patients who underwent reoperation were younger at the time of first surgery (mean age, 13.15 ±1.68 vs 18.58 ± 0.92 months [P = 0.005]). Patients who developed consecutive esotropia were younger at the time of initial operation (P = 0.039). Among 20 patients who were testable for sensory outcome assessment, only 4 patients developed stereopsis, whereas 15 patients achieved bifixation by Worth 4-Dot test. All of the 4 patients with measurable postoperative stereoacuity had initial surgery after 1 year of age.

In this patient cohort, earlier surgery did not necessarily lead to better sensory outcomes, and reoperation was associated with younger age at time of first surgery.