Surgical outcomes of intermittent and constant exotropia in an adult population between 18 and 60 years old.

BACKGROUND: Comitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment approaches and help establish realistic expectations for patients and clinicians. METHODS: Retrospective chart review of adults 18-60 years old who underwent surgery for comitant exotropia between 2014 and 2024 at a single institution. Patients were classified as intermittent (X(T)) or constant exotropia (XT) and divided into three groups: basic exotropia (BXT), divergence excess (DEXT) and convergence insufficiency (CIXT). Surgical motor success was defined as a postoperative deviation≤10 prism dioptres (PDs) and sensory success as resolution of diplopia. RESULTS: 165 patients (mean age 38.2±12.1 years, 50.3% male) were included. The mean preoperative deviation was 44.8±17.5 PD at distance and 48.3±20.1 PD at near. After initial surgery, the overall motor success was 62.4%, highest in BXT (69.4%), followed by CIXT (52.8%) and DEXT (50%) (p=0.08). Motor success was significantly higher in X(T) than XT (69.2% vs 52.2%, p=0.026), and in cases with adjustable sutures rather than non-adjustable (p=0.033), however, similar in unilateral recess-resect and bilateral lateral rectus recessions (62.7% vs 59.1%, p=0.81). Preoperative diplopia was present in 28.5% (47/165) and resolved in 89.4% (42/47). The final motor success was 66.7% after a second surgery in nine patients. CONCLUSIONS: The motor outcomes in adults are comparable to those reported in children. Higher motor success is found in X(T) and with the use of adjustable sutures. Surgical intervention provides relief of diplopia and meaningful gains in stereopsis.

Duke Scholars

Author Jiaxing Wang Ophthalmology