What question did this study set out to answer?

This study aims to evaluate changes in postoperative exodrift after surgical treatment for children with basic type intermittent exotropia.

February 2, 2026Open Access

A cohort study of exodrift following the recession-plication technique for the treatment of basic type intermittent exotropia in children

Key Points

This study aims to evaluate changes in postoperative exodrift after surgical treatment for children with basic type intermittent exotropia.
Conducted a retrospective review of clinical data on patients treated for basic type IXT from 2022 to 2023.
Divided patients into three groups based on early postoperative ocular alignment: exo, ortho, and eso.
Assessed motor outcomes defined by exodeviation and esodeviation at follow-up.
Final exodrift magnitudes were similar across all groups with average values of around 10 PD.
Patients showing overcorrection during the early period had better motor outcomes than those with undercorrection.
Fusion function improved significantly regardless of early postoperative ocular alignment.

Abstract

Background: Intermittent exotropia (IXT) is a prevalent strabismus in Asian children. While surgery is the main treatment, its long-term success can be influenced by postoperative exodrift. Therefore, accurately assessing this exodrift is essential to determine the optimal early postoperative alignment. Objectives: To investigate postoperative exodrift changes following unilateral lateral rectus recession combined with medial rectus plication (RP) procedure for children with basic type intermittent exotropia (IXT). Design: Retrospective, Cohort study. Methods: A retrospective review was conducted on the clinical data of patients with basic type IXT who underwent surgical intervention between 2022 and 2023, with a minimum follow-up of 12 months. Based on the postoperative ocular alignment at near within the first week, patients were divided into three groups: Group exo with exodeviation equal or exceeding 5 prism diopter (PD); Group ortho with exodeviation or esodeviation less than 5 PD; and Group eso with esodeviation equal or exceeding 5 PD. The successful motor outcome was defined as exodeviation or esodeviation equal to or less than 10 PD. The recurrent exotropia was defined as exodeviation exceeding 10 PD, and consecutive esotropia was defined as esodeviation exceeding 10 PD. The clinical features associated with motor outcomes and sensory outcomes were analyzed. Results: Final exodrift magnitudes were comparable across groups: Group exo (distance: 10.18 ± 10.55 PD, near:7.71 ± 9.82 PD), Group ortho (distance: 8.27 ± 7.23 PD, near: 9.13 ± 8.13 PD), Group eso (distance: 12.50 ± 10.71 PD, near: 12.80 ± 11.69 PD), ( p = 0.149 for distance; p = 0.157 for near). Patients exhibiting overcorrection and ortho during the early postoperative period tended to have a better motor outcome compared to those undercorrection. Fusion function improved significantly regardless of the early postoperative ocular alignment ( p < 0.001). Conclusion: Children with basic type IXT who exhibit varying ocular alignment in the early postoperative period demonstrated a comparable magnitude of 10 PD for long-term exodrift. It is recommended to overcorrect within the range of 0 to 10 PD following RP techniques.

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