Distinct Pattern Observed After Intermittent Exotropia Surgery: Characteristics of Patients Exhibiting Postoperative Rebound Esodrift

Purpose: To investigate the unique postoperative pattern following intermittent exotropia (IXT) surgery. Methods: A retrospective review of patients younger than 18 years who underwent bilateral lateral rectus (BLR) recession or unilateral lateral rectus weakening and medial rectus strengthening surgery for IXT, with a postoperative follow-up period of 2 years or more was done. Patients who developed esodeviation after initially recovering to orthotropia within 1 month postoperatively were classified as having delayed-onset consecutive esotropia. The clinical characteristics of these patients were analyzed and the associated preoperative factors were assessed. Results: Delayed-onset consecutive esotropia was observed in 6.4% of patients after IXT surgery. This phenomenon was observed approximately 4 months postoperatively. Risk factors were younger age, larger preoperative deviation angles, and undergoing BLR recession. Similar phenomenon of worsening of the deviation angle toward esotropia (rebound esodrift) was also observed in the patient groups with constant exotropia and continuous consecutive esotropia. Patients showing rebound esodrift shared the same risk factors as those with delayed-onset consecutive esotropia. Conclusions: This study identified patients exhibiting delayed-onset consecutive esotropia in the early postoperative period following IXT surgery. Close monitoring and suitable treatment of these patients are essential for optimal outcomes.