Surgical Outcomes of Patients With Mild to Moderate Exodeviation With and Without Combined Superior Oblique Palsy.

Abstract

Purpose: To compare surgical outcomes in pediatric patients with superior oblique palsy and exodeviation to those with isolated intermittent exotropia lacking a vertical component, with a focus on the horizontal components in both groups.

Methods: This was a retrospective analysis of patients undergoing strabismus surgery from January 2010 to September 2022 in a single tertiary hospital's pediatric ophthalmology unit. The superior oblique palsy and exodeviation group was matched with the intermittent exotropia control group. All patients included had an exodeviation of 25 prism diopters (PD) or less. Surgical success was defined by residual horizontal strabismus of 10 PD or less or residual vertical deviation of 4 PD or less, and lack of additional surgery for residual or consecutive strabismus.

Results: Among 45 eligible patients, 17 were in the superior oblique palsy and exodeviation group and 28 in the isolated intermittent exotropia group. At follow-up, patients with combined superior oblique palsy and exotropia exhibited significantly lower horizontal measurements at distance (1.8 ± 2.5 vs 6.6 ± 6.6 PD, P = .006) and near (1.9 ± 3.3 vs 7.4 ± 6.8 PD, P = .004). Additional surgery rates were also lower in this group (5.9% vs 21.4%). One patient with superior oblique palsy and exotropia had residual exotropia exceeding 10 PD (5.9%), compared to 21.4% in the intermittent exotropia group. The success rate was higher in the mixed group (88.2% vs 57.1%, P = .045). Multivariate regression analysis demonstrated that the type of strabismus (P = .013) and shorter follow-up (P = .004) emerged as significant predictors of a successful surgical outcome.

Conclusions: Patients with small to moderate superior oblique palsy and exodeviation demonstrated superior surgical outcomes for their exodeviation compared to those with small to moderate isolated intermittent exotropia, emphasizing the distinction between these groups and the potential impact on surgical expectations. These findings highlight the need for extended follow-up in intermittent exotropia cases.