The Success of Unilateral Surgery for Constant and Intermittent Exotropia and Factors Affecting It in a Large Scandinavian Case Series

PURPOSE: To compare the results of surgery for constant and intermittent exotropia, to determine factors affecting surgical success, and to evaluate the effect of horizontal rectus muscle surgery on distance-near incomitance. METHODS: In this retrospective study of 291 Scandinavian patients, inclusion criteria were surgery for constant (n = 101) or intermittent (n = 190) exotropia with no vertical deviation, no previous strabismus surgery, and available postoperative follow-up data. Medical records of patients (age: 3 to 85 years) undergoing surgery were reviewed. Surgical success was defined as postoperative esodeviation of less than 5 prism diopters (PD) to exodeviation of 10 PD or less. RESULTS: Surgical success was 70% in constant exotropia and 80% in intermittent exotropia (P > .05). At follow-up 1.5 years after surgery, a significant drift was found in intermittent exotropia (P .05). The surgical success rate increased with decreasing preoperative angle (P < .05). Resection of the medial rectus muscle had a greater effect on the near deviation, whereas recession of the lateral rectus muscle had a greater effect on the distance deviation (P < .05). CONCLUSIONS: Surgical success was equally good in constant and intermittent exotropia, but better long-term stability was observed following surgery for constant exotropia. The only factor affecting surgical success was the preoperative deviation, with smaller deviations having a better outcome. A distance-near incomitance may be an important consideration in choosing the magnitude of medial versus lateral rectus muscle surgery. J Pediatr Ophthalmol Strabismus. 2021;58(1):34-41..