Early versus late surgery for infantile exotropia

Purpose: To determine whether age at surgery influences postoperative outcome in infantile exotropia. Methods: This longitudinal, retrospective study included children who underwent bilateral lateral rectus recession between 2004 and 2012 for an exotropia with onset by 12 months of age. Surgical outcomes were considered failures if recurrence with exodeviation of >8^Δ or overcorrection with esodeviation of >5^Δ developed during postoperative period. Univariate and multivariate analyses were conducted to compare the association of age at surgery with development of recurrence and overcorrection. Results: A total of 93 children were included. Mean age at surgery was 3.2 years. At a mean follow-up of 3.6 years, 19 of 93 patients (20.4%) experienced recurrence and 3 (3.2%) had overcorrection. In the multivariate analyses, increased age at surgery was associated with higher risk for recurrence (OR = 1.031 per 1-month; 95% CI, 1.003-1.060). In subgroup analyses, the association was significant only in the constant exotropia group (OR = 1.410; 95% CI, 1.037-1.917) and not in the intermittent exotropia group (OR = 0.995; 95% CI, 0.938-1.056). In both groups, overcorrection was not associated with any factors, including age at surgery. Conclusions: Older age at surgery was associated with risk of recurrence in infantile exotropia with constant deviation, but it was not correlated with surgical outcomes for patients with intermittent exotropia in this study.