Related Experiment Video
Updated: Jan 12, 2026
Endoscopic Septoplasty with Limited Two-line Resection: Minimally Invasive Surgery for Septal Deviation
Published on: June 20, 2018
Surgical Outcomes of Patients With Mild to Moderate Exodeviation With and Without Combined Superior Oblique Palsy
Miriam Ehrenberg1,2, Gad Dotan1,2, Ronit Friling1,2
1Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Insights
Pediatric patients with superior oblique palsy and exodeviation had better surgical outcomes for their exodeviation than those with isolated intermittent exotropia. This highlights differences in surgical expectations and the need for longer follow-up in intermittent exotropia cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Superior oblique palsy (SOP) with exodeviation presents unique challenges in pediatric strabismus management.
- Isolated intermittent exotropia (IXT) lacks a vertical deviation component, differing clinically from SOP with exodeviation.
Purpose of the Study:
- To compare surgical outcomes of exodeviation in pediatric patients with SOP and exodeviation versus those with isolated IXT.
- To analyze horizontal alignment and success rates in these distinct strabismus groups.
Main Methods:
- Retrospective analysis of 45 pediatric strabismus surgery patients (Jan 2010-Sep 2022).
- Matched groups: SOP with exodeviation (n=17) and isolated IXT (n=28), with exodeviation ≤25 PD.
- Surgical success: residual horizontal strabismus ≤10 PD, residual vertical deviation ≤4 PD, no reoperation.
Main Results:
- SOP with exodeviation group showed significantly lower distance (1.8 vs 6.6 PD) and near (1.9 vs 7.4 PD) exodeviation.
- Lower reoperation rates (5.9% vs 21.4%) and higher success rates (88.2% vs 57.1%) in the SOP with exodeviation group.
- Strabismus type and shorter follow-up were predictors of surgical success.
Conclusions:
- Pediatric patients with SOP and exodeviation achieve superior surgical outcomes for exodeviation compared to isolated IXT.
- These findings necessitate distinct surgical expectations and management strategies for each group.
- Extended follow-up is crucial for managing intermittent exotropia cases.
Purpose:
To compare surgical outcomes in pediatric patients with superior oblique palsy and exodeviation to those with isolated intermittent exotropia lacking a vertical component, with a focus on the horizontal components in both groups.
Methods:
This was a retrospective analysis of patients undergoing strabismus surgery from January 2010 to September 2022 in a single tertiary hospital's pediatric ophthalmology unit. The superior oblique palsy and exodeviation group was matched with the intermittent exotropia control group. All patients included had an exodeviation of 25 prism diopters (PD) or less. Surgical success was defined by residual horizontal strabismus of 10 PD or less or residual vertical deviation of 4 PD or less, and lack of additional surgery for residual or consecutive strabismus.
Results:
Among 45 eligible patients, 17 were in the superior oblique palsy and exodeviation group and 28 in the isolated intermittent exotropia group. At follow-up, patients with combined superior oblique palsy and exotropia exhibited significantly lower horizontal measurements at distance (1.8 ± 2.5 vs 6.6 ± 6.6 PD, P = .006) and near (1.9 ± 3.3 vs 7.4 ± 6.8 PD, P = .004). Additional surgery rates were also lower in this group (5.9% vs 21.4%). One patient with superior oblique palsy and exotropia had residual exotropia exceeding 10 PD (5.9%), compared to 21.4% in the intermittent exotropia group. The success rate was higher in the mixed group (88.2% vs 57.1%, P = .045). Multivariate regression analysis demonstrated that the type of strabismus (P = .013) and shorter follow-up (P = .004) emerged as significant predictors of a successful surgical outcome.
Conclusions:
Patients with small to moderate superior oblique palsy and exodeviation demonstrated superior surgical outcomes for their exodeviation compared to those with small to moderate isolated intermittent exotropia, emphasizing the distinction between these groups and the potential impact on surgical expectations. These findings highlight the need for extended follow-up in intermittent exotropia cases.
