Peer-reviewed article
Factors associated with the recurrence of intermittent exotropia and reoperations in the long term.
Pedro Lino, Pedro Aguiar, João Paulo Cunha ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This is a medical study about eye muscle surgery outcomes in children with intermittent exotropia (a form of strabismus). The research examined risk factors for needing repeat surgery after bilateral lateral rectus recession in 258 children over a 10-year period. The study found that initial surgical failure, larger eye deviation angles, and older age at surgery predicted the need for reoperation.
Key points
- 11% of children required reoperation after initial surgery
- Failed initial surgery was the strongest predictor of reoperation (34.7 times higher risk)
- Larger preoperative deviation angles increased reoperation risk
- Larger immediate postoperative deviation paradoxically reduced reoperation risk
- Patient age had a modest effect on reoperation likelihood
Limitations
This is a single-centre retrospective study with no comparison or control group, limiting generalizability. The study does not assess broader child well-being outcomes or quality of life impacts of the condition or treatment.
Abstract
PURPOSE: To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation. METHODS: A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ2 tests, and variables with p < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer-Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at p < 0.05. RESULTS: Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7; p < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062-1.231; p < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766-0.881; p < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032-1.542; p = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends. CONCLUSION: In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having the modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.