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

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.