The clinical effect of surgical timing in infantile exotropia.

PURPOSE: To review the association of postoperative ocular alignment, sensory outcomes, and need for reoperation after surgical management of infantile exotropia.

METHODS: The clinical records of patients who presented with constant infantile exotropia of >25Δ and subsequently underwent strabismus surgery at a single center from 2004 to 2014 were reviewed retrospectively. Postoperative binocular sensory status was assessed using Worth 4-Dot and Titmus stereoacuity tests. Patients with postoperative exotropia of >10Δ or esotropia of >5Δ were advised to undergo additional surgery.

RESULTS: A total of 49 cases were included (28 boys; age at diagnosis, 1-12 months). The patients who underwent reoperation were younger at the time of first surgery (mean age, 13.15 ±1.68 vs 18.58 ± 0.92 months [P = 0.005]). Patients who developed consecutive esotropia were younger at the time of initial operation (P = 0.039). Among 20 patients who were testable for sensory outcome assessment, only 4 patients developed stereopsis, whereas 15 patients achieved bifixation by Worth 4-Dot test. All of the 4 patients with measurable postoperative stereoacuity had initial surgery after 1 year of age.

CONCLUSIONS: In this patient cohort, earlier surgery did not necessarily lead to better sensory outcomes, and reoperation was associated with younger age at time of first surgery.