Predictors and efficacy of surgical treatment for consecutive exotropia

To study the surgical outcomes of consecutive exotropia and predictive factors, and to compare the medial rectus (MR) advancement, lateral rectus (LR) recession, or a combination of both procedures.

A retrospective study of patients diagnosed with consecutive exotropia that were operated on (2000-2020) were included. The convergence was classified from 0 to +++, with good: ++/+++ and poor: 0/+. A good outcome was considered when the final horizontal deviation was < 10 prism diopters (pd). Follow-up since the surgery and the number of reoperations were registered.

A total of 88 cases were analyzed, mean age: 33.98 ± 17.68 years (57.95%: women). The near and distance horizontal deviation mean (±SD) was 34.3 pd (±16.45) and 34.36 pd (±16.33), respectively. MR advancement was performed in 36.36%, LR recession in 27.27%, and a combination of both in 36.36%. Surgery was unilateral in 65.91% (bilateral in 34.09%). A good outcome was obtained in 69.32% and reoperations in 11.36%. The insufficiency convergence was associated with a bad outcome. The near horizontal deviation (P = .006), the vertical deviation (VD) association (P = .036) and the combination of both MR advancement and LR recession (P = .017) were predictors of a bad result. The mean follow-up was 56.5 months ± 57.65.

A long-term good surgical result was obtained in most patients. The greatest near deviation, the VD association, and the combination of MR advancement and the LR recession were predictive factors for bad results.