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Related Experiment Video

Updated: Jan 13, 2026

Surgical Correction for Pediatric Epiblepharon and Trichiasis
03:59

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Preoperative factors associated with multiple strabismus surgeries in basic exotropia.

Mohammad Reza Akbari1, Babak Masoomian1, Arash Mirmohammadsadeghi1

  • 1Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.

Therapeutic Advances in Ophthalmology
|January 9, 2026
PubMed
Summary

Patients needing multiple surgeries for basic unilateral exotropia often have worse vision and more hyperopia before their first operation. Optimizing early treatment can reduce the need for further strabismus surgeries.

Keywords:
amblyopiaexodeviationexotropiareoperationstrabismus surgery

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Area of Science:

  • Ophthalmology
  • Strabismology
  • Pediatric Ophthalmology

Background:

  • Basic unilateral exotropia is a common form of strabismus.
  • Surgical intervention is the primary treatment for exotropia.
  • Predicting the number of surgeries required can aid in patient counseling and management.

Purpose of the Study:

  • To compare preoperative clinical features of patients with basic unilateral exotropia undergoing one, two, or three or more strabismus surgeries.
  • To identify preoperative factors associated with the need for multiple surgical interventions.

Main Methods:

  • Retrospective analysis of 2,457 patients with unilateral basic exotropia over 10 years.
  • Data collected included best corrected distance visual acuity (BCVA), refractive error, exotropia magnitude, and amblyopia severity.
  • Statistical analysis compared preoperative characteristics across groups based on the number of surgeries.

Main Results:

  • Patients requiring three or more surgeries had significantly worse preoperative BCVA and were more hyperopic than those needing one or two surgeries.
  • Undergoing two surgeries was linked to larger exotropia magnitude, while three or more surgeries were associated with amblyopia severity and higher spherical power.
  • No significant difference in age at first surgery was found between groups.

Conclusions:

  • Worse preoperative BCVA, greater hyperopia, and larger angle of deviation predict the need for multiple surgeries in basic unilateral exotropia.
  • Optimizing preoperative refractive correction and amblyopia management is crucial.
  • High-risk patients should be counseled on the potential need for additional surgical procedures.