• Pediatric Ophth/Strabismus

    Review of: The Relationship of Age and Other Baseline Factors to Outcome of Initial Surgery for Intermittent Exotropia

    Repka M, Chandler D, Holmes J, et al. American Journal of Ophthalmology, April 2020

    This study assessed whether age at time of surgery for intermittent exotropia correlates with outcomes at 3 years.

    Study design

    This was a secondary analysis of pooled prospective data. The study included 197 children (3–11 years) with intermittent exotropia (15–40 prism diopters) who were randomized to bilateral lateral rectus recessions or unilateral lateral rectus recession with medial rectus resection.


    Strabismus surgery at a younger age (3–5 years) associated with better surgical outcomes. At the 3-year follow-up, the cumulative probability of suboptimal surgical outcomes in younger children was 28% compared with 50% in children aged 5 to 11 years. Surgical success was similar regardless of type of surgery. The probability of reoperation was lower in younger children (1% vs. 11%).


    This was a secondary analysis of the PEDIG intermittent exotropia study. The baseline characteristics between the older and younger children were reasonably similar. However, there may have been differences due to a larger proportion of younger children who were not able to be accurately assessed for binocular fixation and who had a more difficult time with stereoacuity testing. In addition, the study was limited to intermittent exotropia between 15 and 40 prism diopters.

    Clinical significance

    Strabismus surgery for intermittent exotropia is often indicated in children. This study suggests that surgery at a younger age of 3 to 5 years may result in better surgical outcomes and fewer reoperations.