Early postoperative alignment and preoperative stereopsis as determinants of success in intermittent exotropia surgery

To assess the surgical outcomes of patients with intermittent exotropia (IXT) and identify factors influencing surgical success in a tertiary hospital setting. This retrospective study included 150 patients who underwent surgical correction for IXT of less than 50 prism diopters between 2013 and 2024. Stereopsis was evaluated using the Randot stereo test. Surgical success was defined as residual exotropia <10 prism diopters without diplopia symptoms. Preoperative variables were analyzed to determine predictors of surgical success. Surgical success was achieved in 74% (111/150) of patients. The sensory status at one year was 83.46% (111/133). The procedures performed were bilateral lateral rectus recession (56%) and unilateral recess-resection (44%). Preoperative stereopsis and postoperative overcorrection at one week were significantly associated with successful outcomes, with adjusted odds ratios of 2.81 (95% CI, 1.14–6.93) and 4.56 (95% CI, 1.60–12.96), respectively. Reoperations were required in 7.3% (11/150) of cases. Favorable ocular alignment was sustained postoperatively during the first six months but gradually declined over time. Surgical management of IXT demonstrated good motor outcomes, with preoperative stereopsis and postoperative at 1 week overcorrection identified as key factors for success. Further prospective studies are warranted to validate these findings and explore additional predictive factors.