Indications and results of exotropia surgical management.

Aim: To study the clinical particularities and the surgical management of the different forms of exotropia, and to analyze the prognostic factors influencing the surgical result.

Methods: Medical records of 132 patients who underwent exotropia surgery from 1995 to 2015, were retrospectively reviewed. Ophthalmological examination and a complete sensorimotor assessment were performed for each patient. All surgeries were performed by the same surgeon.

Results: We had 57 cases of intermittent exotropia (IE), 22 cases of infantile exotropia (IfE), 43 cases of sensory exotropia (SE) and 10 cases of concecutive exotropia (CE). The average age of onset of exotropia was 6.8 years +/- 8 SD. Amblyopia was noted in 36.4% of cases  of  IfE.  The mean deviation angle was  36.5  DP in (IE),  39.6  DP in (IfE)  and  44.5  DP  in  (SE). A vertical syndrome was frequently found in (IfE) patients. Bilateral recession of  lateral  rectus  was  the  most  performed  surgery  type.  The overall success rate after a  single  surgery  was  72%.  A multivariate logistic regression analysis  showed  that good prognosis  factors  were  the absence  of  amblyopia, the intermittent form of the strabismus,  a low  preoperative deviation angle and the ocular alignment on day one postoperatively.

Conclusions: IE is the most common divergent strabismus.  Surgery resulted in successful alignment in most of the cases.  Early management and rigorous analysis of  patients sensorimotor status are the best guarantors of long-term success.