Factors Associated with Surgical Outcomes after Bilateral Lateral Rectus Recession in Children with Intermittent Exotropia

Abstract

Purpose : There are controversis regarding the impact of intermittent exotropia (IXT) on postoperative outcomes. This study aims to evaluate factors associated with surgical outcomes after bilateral lateral rectus recession(BLR) in children with IXT.

Methods : A retrospective, observational clinical study was performed for 125 patients who had undergone BLR surgery with at least one year of follow up. Surgical outcomes were grouped as success (esophoria/tropia ≤ 5 prism diopers (PD) to exophoria/tropia ≤ 10 PD), failure (esotropia > 5PD or exotropia > 10PD) according to the angle of deviation at postoperative one year. We investigated subjects’ clinical and demographic factors including magnitude of exo-deviation, stereoacuity at near and distance, and response to patching at 3 months after patching. Factors associated with surgical outcomes were then determined through univariate and multivariate analyses.

Results : Of a total of 125 patients, 102 (81.6%) were assigned to the success group and 23 (18.4%) to the failure group. Univariate analysis revealed that absence of anisometropia, smaller preoperative near exodeviation, better stereopsis at near, magnitude of deviation at postoperative day 1, and good response to preoperative patching were significantly associated with surgical success for IXT at postoperative one year. In multivariate analysis, distant esotropic deviation at postoperative day 1 was the only factor affecting successful surgical outcome.

Conclusions : Esotropic distant deviation at postoperative day 1 is prognostic factor affecting favorable surgical outcome. Preoperative patching might be additional factor that could be altered with an effort to lead to surgical success in IXT children.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.