Factors Associated with Improved Surgical Outcomes in Recurrent Exotropia

ABSTRACT

PURPOSE: To investigate the factors that improve the success rate in patients with recurrent exotropia. METHODS: A total of 60 patients who had undergone reoperation for recurrent exotropia and had at least 1 year of follow-up after surgery were included in this study. In total, 43 patients in the group with one-muscle surgery had undergone either unilateral medial rectus resection or unilateral lateral rectus recession, and the other 17 patients in the group with two-muscle surgery had undergone either bilateral medial rectus resection or lateral rectus muscle recession with medial rectus muscle resection of contralateral eye. The main outcome measure was final success rate, which was compared between the 2 groups. RESULTS: In this study, 41 (95.3%) of 43 patients in the group with one-muscle surgery had successful outcomes, while 2 (4.7%) had undercorrection at the final follow-up examination. On the other hand, 10 (58.8%) of 17 patients in the group with two-muscle surgery had successful outcomes, 5 (29.4%) had undercorrection, and 2 (11.8%) had overcorrection. The success rates were significantly different between the 2 groups (p = 0.001). In addition, preoperative deviation had the largest area under the receiver operator characteristic (ROC) curve for the success rate and exhibited an optimal balance of both sensitivity and specificity using a cut-off value of 25 PD. CONCLUSIONS: Final success rate was higher in the group with one-muscle surgery for the treatment of recurrent exotropia. Surgical outcomes are expected to be higher in patients with preoperative deviation of less than 25 PD.