Factors Associated with the Prognosis after Operation in Children with Recurrent Intermittent Exotropia

Background: To describe factors affecting the prognosis after operation for recurrent intermittent exotropia (X[T]) in children. Methods: Clinical records of 50 patients who underwent operation for recurrent X(T) by a single surgeon were reviewed. The age at diagnosis of X(T), and first and second operations, deviation angle at distance and near, surgical method, concurrent vertical strabismus, stereoacuity, and Worth's Four Dot (W4D) examination before reoperation were analyzed, along with the postoperative deviation angle. A successful surgical outcome was defined as orthophoria, esodeviation <= 5 prism diopters, or exodeviation <= 10 prism diopters at distance. Results: Among the 50 recurrent exotropes who underwent surgery and were followed up for more than 1 year postoperatively, 13 showed recurrent exotropia and 1 showed consecutive esotropia. The mean age at reoperation was 8.49 +/- 2.19 years, and the mean duration of postoperative follow-up was 27.78 +/- 12.02 months. Good near fusion before reoperation was a significant factor in the success of surgery (P= 0.006). Smaller postoperative deviation angle measured immediately and 2 months after surgery were related to smaller final deviation angle (P= 0.027 and P= 0.022, respectively). Conclusion: Peripheral suppression lowers the success rate of operation for recurrent X(T) in children. Overcorrection rather than orthotropia should be the target of immediate postoperative deviation angle. Peripheral suppression status and immediate and 2-month postoperative deviation angle may be important cities for predicting the final result of operation for recurrent X(T).