Major Article
Long-term results of the surgical management of intermittent exotropia

Presented at the 36th Annual Meeting of the American Association for Pediatric Ophthalmology and Strabismus, Orlando, Florida, April 14-18, 2010.
https://doi.org/10.1016/j.jaapos.2010.06.007Get rights and content

Purpose

To examine long-term surgical success rates (>10 years) for patients with intermittent exotropia and the risk factors for failure of surgery in these patients.

Methods

An attempt was made to contact all patients who underwent surgical treatment for intermittent exotropia between the years of 1970 to 1998 with a minimum postoperative follow-up of 10 years. Each patient underwent a detailed sensory and motor examination, including measurements of near and distance stereoacuity, cover testing, and ocular rotations. Patients were classified as achieving an excellent, fair, or poor outcome on the basis of motor and sensory outcomes. Risk factor analysis was performed to evaluate associations with a poor outcome and reoperations.

Results

Of 197 patients identified, 50 were reevaluated. When combined motor/sensory criteria for surgical success were used, we found that 38% of patients achieved an excellent outcome, whereas 34% and 28% achieved a fair or poor outcome, respectively. When only the motor criteria were used, we found that 64% had an excellent outcome, whereas the remaining patients achieved either a fair (18%) or a poor (18%) outcome. During the follow-up period, 60% of patients required at least one reoperation. Multivariate risk factor analysis determined that anisometropia (p = 0.03) was associated with a poor outcome, whereas postoperative undercorrection (p = 0.04) and lateral incomitance (p = 0.06) were associated with reoperations.

Conclusions

Long-term surgical results in intermittent exotropia are less encouraging when sensory status is added to the evaluation. Patients with anisometropia, lateral incomitance, and immediate postoperative undercorrection are at increased risk for poor outcomes and to require reoperations.

Section snippets

Methods

This study was approved by the University of California Los Angeles Institutional Review Board and conformed to the requirements of the United States Health Insurance Portability and Accountability act; all subjects gave written informed consent before participation in conformity with the Declaration of Helsinki.

The surgical records of all cases from 1970 to 1998 of one surgeon (ALR) were reviewed. An attempt was made to contact all patients who underwent surgery for intermittent exotropia

Patient Characteristics

A total of 197 patients met the inclusion criteria. Of these, 60 could be reached via telephone. Fifty patients were able to return for an examination. The remaining 10 patients did not reside in the area and therefore were unable to participate. In the 50 subjects, the mean age at the time of the study examination was 28.6 ± 17.6 years (range, 11-75 years). The mean age at the time of the first surgery was 14.3 ± 17.7 years (range, 2-65 years). The mean number of years since the first surgery

Discussion

This study represents the largest single-surgeon series of patients with intermittent exotropia, with a minimum of 10 years' follow-up from the first procedure. In our cohort, patients were almost evenly distributed amongst excellent, fair, and poor outcomes when stringent sensory and motor criteria were used. When we eliminated the sensory criteria from the analysis, the number of patients with an excellent result increased, and the percentage of patients with a poor result decreased. Within

Literature Search

The authors performed a MEDLINE search without date restrictions for the following terms: intermittent exotropia, alternating exotropia, strabismus, and strabismus surgery. Additionally, articles not initially found on MEDLINE but referenced in review papers were also included.

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  • Cited by (0)

    Dr. Pineles is the recipient of the Heed Fellowship and The Leonard Apt Fellowship; Dr. Rosenbaum was the recipient of Research to Prevent Blindness Physician-Scientist Merit Award.

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