Factors associated with the recurrence of intermittent exotropia and reoperations in the long term.

[PURPOSE] To evaluate long-term reoperation risk after bilateral lateral rectus (BLR) recession for intermittent exotropia (IXT) in a paediatric cohort, and to identify the perioperative factors associated with recurrence and reoperation.

[METHODS] A retrospective observational cohort of 258 children with basic or divergence-excess IXT who underwent BLR recession at CUF Cascais Hospital between 2010 and 2020 was analysed. Clinical variables included age, age at surgery, pre- and immediate postoperative deviation angles, preoperative occlusion therapy, orthoptic treatment, binocular function, and initial surgical success (residual deviation <10 prism dioptres with fusion). Bivariate analyses were performed using t-tests or χ tests, and variables with  < 0.10 were entered into multivariable binary logistic regression to identify the independent predictors of reoperation. Model diagnostics included variance inflation factors (VIF), Hosmer-Lemeshow test, and area under the receiver operating characteristic curve (AUC). Significance was set at  < 0.05.

[RESULTS] Reoperation was required in 11% of cases. Failed initial surgery (adjusted OR = 34.7;  < 0.001), larger preoperative deviation (adjusted OR per PD = 1.143; 95% CI 1.062-1.231;  < 0.001), larger immediate postoperative deviation (adjusted OR per PD = 0.822; 95% CI 0.766-0.881;  < 0.001), and older patient age (adjusted OR per year = 1.261; 95% CI 1.032-1.542;  = 0.024) were independently associated with reoperation. Orthoptic and occlusion therapies showed non-significant trends.

[CONCLUSION] In children undergoing BLR for IXT, initial surgical failure and deviation magnitude (pre- and immediate postoperative) are the strongest predictors of reoperation, with age having the modest additional effect. These findings emphasize precise surgical planning and the need for long-term follow-up.