Do Exotropic Patients Show More Exotropic Drift Postoperatively Than Esotropic Patients?

Abstract

Purpose: To quantify changes in ocular alignment following strabismus surgery and identify relevant variables. It was hypothesized that exotropic patients would exhibit greater postoperative exotropic drift than esotropic patients.

Methods: A retrospective chart review was conducted on all patients who underwent horizontal strabismus surgery between 2018 and 2023. Of the 629 charts reviewed, 243 were excluded due to insufficient data, nystagmus, or concomitant superior rectus, inferior rectus, or superior oblique surgery. Postoperative drift was calculated by subtracting alignment measured between postoperative days 1 to 14 and days 30 to 150. An unpaired t test was used to compare postoperative drift between exotropic and esotropic patients. Additional variables collected included preoperative magnitude of deviation, age, and surgical technique.

Results: A total of 386 patients met the inclusion criteria. Among 208 exotropic patients, mean postoperative drift was exotropic 9.94 △ ± 9.78 △. Among 178 esotropic patients, mean postoperative drift was esotropic 1.26 △ ± 9.81 △. Exotropic patients demonstrated significantly greater exotropic drift than esotropic patients (P < .001).

Conclusions: Postoperative drift varies significantly between exotropic and esotropic patients, with exotropic patients exhibiting greater drift. These findings may inform pre- and postoperative counseling, prognostic expectations, and surgical planning. The wide range of observed postoperative drift highlights the variability in surgical outcomes.