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Surgical Correction for Pediatric Epiblepharon and Trichiasis
Published on: July 8, 2025
Factors associated with the recurrence of intermittent exotropia and reoperations in the long term
Pedro Lino1,2,3, Pedro Aguiar1, João Paulo Cunha4,5
1NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Center, CHRC, LA-REAL,CCAL, NOVA University Lisbon, Lisbon, Portugal.
Insights
Reoperation after bilateral lateral rectus recession for intermittent exotropia is predicted by initial surgical failure and deviation magnitude. Older age also increases reoperation risk in pediatric patients.
Area of Science:
- Ophthalmology
- Pediatric Strabismus Surgery
Background:
- Intermittent exotropia (IXT) is a common childhood strabismus.
- Bilateral lateral rectus (BLR) recession is a surgical option for IXT.
- Understanding reoperation risk is crucial for managing pediatric IXT.
Purpose of the Study:
- To assess long-term reoperation rates following BLR recession for IXT in children.
- To identify perioperative factors predicting recurrence and reoperation in pediatric IXT patients.
Main Methods:
- Retrospective cohort study of 258 children with IXT undergoing BLR recession (2010-2020).
- Analysis of clinical variables including age, deviation angles, and prior treatments.
- Multivariable logistic regression identified independent predictors of reoperation.
Main Results:
- 11% of patients required reoperation.
- Independent predictors of reoperation included failed initial surgery (aOR=34.7), larger preoperative deviation (aOR=1.143 per PD), larger immediate postoperative deviation (aOR=0.822 per PD), and older patient age (aOR=1.261 per year).
- Orthoptic and occlusion therapies did not show significant trends for reoperation.
Conclusions:
- Initial surgical success and deviation magnitude are key predictors of reoperation in pediatric IXT treated with BLR recession.
- Older age is a modest predictor of reoperation.
- Precise surgical planning and long-term follow-up are essential for managing IXT.
Purpose:
To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation.
Methods:
A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ2 tests, and variables with p < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer-Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at p < 0.05.
Results:
Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7; p < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062-1.231; p < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766-0.881; p < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032-1.542; p = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends.
Conclusion:
In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having the modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.
