Sensory outcome of exotropia surgery in Thailand: a retrospective multicenter study
Authors:   Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand, Rattanalert Narisa , Surukrattanaskul Supawan ,   Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand, Wongwai Phanthipha ,   Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand, Wangtiraumnuay Nutsuchar ,   Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand, Wuthisiri Wadakarn ,   Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand, Thitiwichienlert Suntaree ,   Department of Ophthalmology, Faculty of Medicine, Thammasat University, Pathum Thani 10120, Thailand, Ployprasith Warassabhorn ,   Ophthalmology Division, Bhumibol Adulyadej Hospital RTAF, Bangkok 10220, Thailand, Pornchaisuree Rattiya ,   Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand, Saksiriwutto Piangporn ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Singha Penny ,   Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand, Thiamthat Warakorn ,   Department of Ophthalmology, Lerdsin Hospital, Bangkok 10500, Thailand, Pukrushpan Parnchat ,   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand, Suwannaraj Sirinya ,   Department of Ophthalmology, Faculty of Medicine, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand, Imsuwan Yutthaphong ,   Department of Ophthalmology, Phramongkutklao Hospital, Bangkok 10400, Thailand, Pornseth Arpha ,   Department of Ophthalmology, Mettapracharak Hospital, Nakhonpathom 73210, Thailand, Wiwatwongwana Atchareeya ,   Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand, Teerakapong Oracha ,   Department of Ophthalmology, Khon Kaen Hospital, Khon Kaen 40000, Thailand, Hiriotappa Juthathip ,   Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok 10400, Thailand, Lekskul Apatsa ,   Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand, Nganthavee Variya ,   Department of Ophthalmology, Rajavithi Hospital, Rangsit University, Bangkok 10400, Thailand, Nunthanid Poonyawee ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Honglertnapakul Worawalun ,   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand, Srimanan Worapot ,   Department of Ophthalmology, Phramongkutklao Hospital, Bangkok 10400, Thailand, Jiaranaisilawong Prangkhwan ,   Department of Ophthalmology, Mettapracharak Hospital, Nakhonpathom 73210, Thailand, Patikulsila Prapatsorn ,   Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand, Tangtammaruk Phantaraporn ,   Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; Department of Ophthalmology, Mettapracharak Hospital, Nakhonpathom 73210, Thailand, Tatritorn Dussadee ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Jiwanarom Thunyaluck ,   Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand; Department of Ophthalmology, Faculty of Medicine, Chiang Mai University, Chiang Mai 50200, Thailand; Department of Ophthalmology, Sanpatong Hospital, Chiang Mai 50120, Thailand, Pruksacholavit Jipada ,   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand, Preechaharn Puncharut ,   Department of Ophthalmology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand; Department of Ophthalmology, Police General Hospital, Bangkok 10330, Thailand, Atchaneeyasakul La-ongsri ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Keokajee Phawasutthi ,   Department of Ophthalmology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok 10330, Thailand, Surachatkumtonekul Thammanoon ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Phamonvaechavan Pittaya ,   Department of Ophthalmology, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand, Wutthiphan Sorot ,   Department of Ophthalmology, Bumrungrad International Hospital, Bangkok 10110, Thailand, Aryasit Orapan ,   Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand, Damthongsuk Parichat ,   Department of Ophthalmology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand, Geater Alan Frederick ,   Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla 90110, Thailand
Published: January 2025

AIM: To evaluate the characteristics of exotropia (XT) and motor-sensory outcomes after surgical correction and to determine the factors associated with sensory outcomes of XT surgery.
METHODS: The medical records of all patients that were diagnosed with XT and underwent strabismus surgery in 13 major government hospitals in Thailand; from January 2012 to December 2019, were retrospectively reviewed. Univariable and multivariable logistic regression were performed to identify factors related to binocular vision.
RESULTS: Data of five hundred and thirty-seven patients were analyzed. Two hundred and twenty-six patients were men (42.1%). The median age of onset was 3 years old [Interquartile range (IQR): 1, 8]. The median age at diagnosis was 9.21 years old (IQR; 4.64, 21.06). intermittent exotropia [X(T)] was the most common type (52.1%); 19.5% of the patients had amblyopia. For refractive error, spherical equivalent refraction on right eye (RE) and left eye (LE) were -0.53±2.45 diopters (D) (range -14.88 to +10 D) and -0.48±2.37 D (range -19.50 to +7.75 D), respectively. The mean angle of deviation at distance and near before surgery were 42.06±14.91 prism diopters (PD) and 40.81±16.09 PD, respectively. Follow-up time after first operation was 2.48±2.27y. Four hundred sixty-two patients (86%) needed only one operation and 299 (55.6%) patients had bilateral lateral rectus recession. At final visit, the mean angles of deviation at distance and near decreased to 5.76±8.96 PD and 5.01±8.73 PD, respectively. After surgery, two hundred seventy-three patients (50.8%) were evaluated for binocular function, but the others did not have result. From multivariable logistic regression in 273 patients, the factors related to better binocular function were type of XT which was X(T) [adjusted odds ratio (aOR) 10.35; 95%CI: 4.73, 22.66] compared to constant XT, without amblyopia (aOR 3.97; 95%CI: 1.84, 8.53), underwent only single operation compared with more than 1 operation (aOR 3.80, 95%CI: 1.58, 9.16), the angle of deviation at near in last visit less than 10 PD better than 10–30 PD with aOR 0.42 (95%CI: 0.18, 0.96) and type of refraction revealed isometropia better than anisometropia with aOR 4.13 (95%CI: 1.19, 14.32).
CONCLUSION: The surgical outcomes of XT within one operation in Thailand is 86%. The factors related to achieve binocular function includes type of XT as X(T), without amblyopia, angle of deviation at final visit less than 10 PD, isometropia type of refraction and underwent only one surgical correction.