Surgical Outcomes for Intermittent Exotropia in a Tertiary hospital in Manila, Philippines

Background. Spontaneous resolution is infrequent, and surgery remains the mainstay for management of intermittent exotropia [X(T)]. Commonly performed procedures to address the exodeviation are (1) bilateral lateral rectus muscle recessions (BLR), (2) unilateral lateral rectus recession with medial rectus resection (monocular R&R), and three- or four-muscle surgery. Despite the different surgical options available, there is still debate as to the most effective surgical treatment for X(T).

Objective. We are interested in describing the outcomes of various strabismus surgeries for X(T) from a local tertiary hospital perspective in the Philippines.

Methods. This is a single-center retrospective chart review study conducted at the Department of Ophthalmology and Visual Sciences of the Philippine General Hospital. 

Results. A total of 25 patients were included in the study, with ages ranging from 4 to 49 years, averaging 5 ± 7.5 years at deviation onset in a predominantly female population (n = 17, 68%). Basic exotropia was the most common type (n = 23, 92%). Surgical outcomes were success (n = 15, 60 %), recurrence (n = 9, 36%), and overcorrection (n = 1, 4%). The most commonly performed procedure was unilateral medial rectus resection-lateral rectus recession (monocular R & R) (n = 11, 44%). Generally, the choice of procedure did not influence success (p-value = 0.968).

Conclusion. In summary, our study demonstrated that surgical interventions for X(T), primarily lateral rectus muscle recessions and medial rectus muscle resections, showed variable success rates, with recurrences observable beginning at 3 months post-operatively. The study acknowledged limitations, particularly a small sample size and challenges with follow-up, cautioning against overgeneralizing results. Despite these limitations, the research contributes to understanding local trends in X(T) surgical outcomes.