Studies find benefits of exotropia surgery last into adulthood

SEATTLE — Most patients treated for exotropia as children maintain visual alignment well into adulthood, although multiple procedures may be necessary to prevent deterioration, according to a surgeon speaking here.

John D. Baker, MD, and colleagues conducted two research studies to better understand surgically corrected pediatric exotropia and the possible origins of adult exotropia. Dr. Baker presented the findings during the Frank D. Costenbader Lecture at the American Association for Pediatric Ophthalmology and Strabismus meeting.

First, Dr. Baker described a project involving 20-year follow-up of 30 patients initially treated surgically for intermittent exotropia as young children at an average age of 5.1 years. Of these 30 children, 21 had one surgery, mainly lateral rectus resection. Another seven children had two surgeries, with a mean interval of 4.5 years between procedures, and two children required three surgeries.

Six of the seven patients who required two surgeries were treated for recurrent intermittent exotropia, while one child required a second procedure for consecutive esotropia. But at 20 years follow-up, all children showed significant stability and good alignment. Also, no patients required further surgery or therapy other than glasses or contact lenses, Dr. Baker said.

In the 20 years since the last clinical examination, most patients achieved a higher educational level than their parents, including several who went to graduate school. Most patients also described their performance as either average or above average, Dr. Baker noted.

In addition, most patients said they enjoyed reading and driving and, in general, reported that their eyes had not affected their careers, he added.

The second part of Dr. Baker's and colleagues' research involved examining the patient histories of adults with exotropia. They found that most patients who did not receive surgery as children were aged at least 30 years by the time they saw an ophthalmologist about their condition.

Based on results from both studies, the researchers concluded that deterioration in patients who have had surgery for intermittent exotropia tends to occur in childhood.

"If, however, we are able to do whatever it takes and maintain alignment into their teens, they will go at least another 20 years and perhaps longer than that [without needing further surgery]," Dr. Baker said.