Outcomes of Consecutive Exotropia Surgery at a Tertiary Eye Hospital in Saudi Arabia

This study aimed to evaluate surgical outcomes, compare success rates, and identify potential risk factors for failure of various surgical procedures for consecutive exotropia.

This retrospective cohort study was conducted at a tertiary eye hospital in Saudi Arabia and included patients with consecutive exotropia treated between 2007 and 2020. Patients with a follow-up of <3 months were excluded. The type of surgery performed was based on surgeon experience and factors, such as the angle of deviation, adduction limitation, and intraoperative findings. Successful outcome was defined as a deviation of ≤10 prism diopters (PD) at the last follow-up visit.

A total of 59 patients were included in this study. Preoperatively, the mean near and distance deviations were 33 ± 14 PD and 32 ± 14 PD, respectively. Among the included patients, 27.1% underwent medial rectus advancement with or without resection, 28.8% underwent lateral rectus recession, and 44.1% underwent combined surgery. At 12 months postoperatively or the last follow-up visit, the overall success rate of distance-deviation correction and near-deviation correction were 80.6% and 67.8%, respectively. Success rates of different surgeries were not significantly different. The severity of amblyopia and number of muscles operated on did not influence the success rate.

Medial rectus advancement and combined medial rectus advancement with lateral rectus recession were associated with better surgical outcomes than lateral rectus recession alone, although the difference was not statistically significant. The only factor that negatively affected the outcome was a high preoperative near angle of deviation.