Impact of preoperative deviation control on one-year motor results after intermittent exotropia surgery
Alaa Alghurab, Mohammad Reza Akbari, Shehzad A. Naroo, Foroozan Narooie-Noori, Elham Azizi, Alireza Akbarzadeh Baghban, Masoud Khorrami-NejadBackground
The prognostic value of preoperative deviation control for motor outcomes after intermittent exotropia (IXT) surgery remains uncertain.
Objectives
To evaluate 12-month surgical outcomes in patients with IXT and identify preoperative factors associated with motor success.
Design
Single-center ambidirectional cohort study.
Methods
Medical records of 112 consecutive surgical patients were screened, of whom 84 with complete data and 12-month follow-up were included (25 fair-control and 59 poor-control). Evaluated parameters included age at onset, age at surgery, corrected distance visual acuity (CDVA), refraction, amblyopia, anisometropia, deviation laterality and magnitude, control status, and surgical procedure. Success was defined as distance alignment between ≤5 prism diopters (PD) of esotropia and ≤10 PD of exotropia.
Results
No statistically significant between-group differences were observed in baseline age at surgery, age at onset, CDVA, or refractive characteristics (all P > 0.05). The poor-control group had significantly larger preoperative deviations at distance (30.5 ± 9.9 vs 24.4 ± 8.1 PD; P=0.003) and near (30.3 ± 11.9 vs 23.4 ± 7.7 PD; P=0.021) than in the fair-control. At 12 months, distance deviation decreased to 6.0 ± 7.2 and 4.4 ± 8.3 PD, while near deviation decreased to 5.4 ± 6.2 and 4.8 ± 7.0 PD in the poor- and fair-control groups, respectively (all P<0.001 versus baseline). Success was achieved in 44 of 59 poor-control patients (74.6%) and 18 of 25 fair-control patients (72.0%). In the overall cohort, surgical success was not significantly associated with preoperative control status, age at surgery, age at onset, CDVA, refractive characteristics, amblyopia, anisometropia, deviation magnitude, laterality, and the surgical procedure (all P > 0.05).
Conclusion
Surgery for IXT resulted in substantial improvement in ocular alignment in patients with both fair and poor preoperative control. Neither baseline control status, nor routinely assessed preoperative visual and refractive characteristics were significantly associated with 12-month motor outcomes.