JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v10i4.14846ArticleMotor Success and Reoperation After Surgery for Adult Intermittent Exotropia: A Systematic Review and Meta-analysishttps://artdesignp.com/journal/JCNR/10/4/10.26689/jcnr.v10i4.14846TaoZhe,QianQijin20261042026-04-30Objective: To estimate pooled motor success and reoperation rates in adult intermittent exotropia (IXT), evaluating the impact of surgical technique, follow-up, and success definitions. Methods: We searched PubMed, Embase, and Scopus (inception–March 2026) for adult (≥ 18 years) intermittent exotropia surgery outcomes. Proportions were Freeman-Tukey transformed and pooled via a random-effects model. We assessed MINORS quality and performed subgroup/sensitivity analyses. Results: This study included 14 studies (18 arms, 793 patients). Pooled motor success was 78.3% (95% CI 72.4–83.8%; I² = 65.0%). Success definition was the sole significant modifier: 83.1% for ≤ 10 prism diopters (PD) exodeviation vs. 67.6% for ≤ 10/5 PD (P = 0.029). Reoperation rates (5 studies) ranged from 0–25%. Conclusion: Adult IXT surgery yields about 78% motor success, with variability primarily driven by inconsistent outcome definitions. Standardizing strict criteria and extending follow-up are essential to accurately characterize long-term outcomes.

Schlossman A, Muchnick R, Stern K, 1983, The Surgical Management of Intermittent Exotropia in Adults. Ophthalmology, 90(10): 1166–1171.

Jeong S, Han S, Kim W, 2024, The Comparison of Postoperative Changes in Subjective Awareness of Exodeviation Between Pediatric and Adult Patients with Intermittent Exotropia. Medicine, 103(25): e38696.

Hatt S, Leske D, Holmes J, 2010, Responsiveness of Health-Related Quality-of-Life Questionnaires in Adults Undergoing Strabismus Surgery. Ophthalmology, 117(12): 2322–2328.e1.

Mills M, Coats D, Donahue S, et al., 2004, Strabismus Surgery for Adults: A Report by the American Academy of Ophthalmology. Ophthalmology, 111(6): 1255–1262.

Kopmann S, Grenzebach U, Ehrt O, et al., 2024, Effectiveness of Strabismus Surgery in Intermittent Exotropia and Factors Influencing Outcome. Journal of Clinical Medicine, 13(4): 1031.

Xu M, Peng Y, Zheng F, et al., 2023, The Effects of Orthoptic Therapy on the Surgical Outcome in Children with Intermittent Exotropia: Randomised Controlled Clinical Trial. Journal of Clinical Medicine, 12(4): 1283.

Page M, McKenzie J, Bossuyt P, et al., 2021, The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews. BMJ, 372: n71.

Slim K, Nini E, Forestier D, et al., 2003, Methodological Index for Non-Randomized Studies (MINORS): Development and Validation of a New Instrument. ANZ Journal of Surgery, 73(9): 712–716.

Freeman M, Tukey J, 1950, Transformations Related to the Angular and the Square Root. Annals of Mathematical Statistics, 21(4): 607–611.

DerSimonian R, Laird N, 1986, Meta-Analysis in Clinical Trials. Controlled Clinical Trials, 7(3): 177–188.

Higgins J, Thompson S, 2002, Quantifying Heterogeneity in a Meta-Analysis. Statistics in Medicine, 21(11): 1539–1558.

Egger M, Davey Smith G, Schneider M, et al., 1997, Bias in Meta-Analysis Detected by a Simple, Graphical Test. BMJ, 315(7109): 629–634.

Balduzzi S, Rücker G, Schwarzer G, 2019, How to Perform a Meta-Analysis With R: A Practical Tutorial. Evidence-Based Mental Health, 22(4): 153–160.

Viechtbauer W, 2010, Conducting Meta-Analyses in R With the Metafor Package. Journal of Statistical Software, 36(3): 1–48.

Choi D, Rosenbaum A, 2001, Medial Rectus Resection(s) With Adjustable Suture for Intermittent Exotropia of the Convergence Insufficiency Type. Journal of AAPOS, 5(1): 13–17.

Khazaeni L, Volpe N, 2006, Adjustable Medial Rectus Muscle Resection in Adult Exotropia. Journal of Pediatric Ophthalmology and Strabismus, 43(4): 225–229.

Lau F, Fan D, Yip W, et al., 2010, Surgical Outcome of Single-Staged Three Horizontal Muscles Squint Surgery for Extra-Large Angle Exotropia. Eye, 24(7): 1171–1176.

Chalifoux E, Alkharashi M, Superstein R, et al., 2016, Adjustable Surgical Treatment of Adult Exotropia: Postoperative Target Angles and Surgical Success. Canadian Journal of Ophthalmology, 51(4): 254–257.

Kamlesh K, Babu S, Goel Y, et al., 2018, Comparison of Adjustable Sutures Versus Nonadjustable Sutures in Intermittent Exotropia. European Journal of Ophthalmology, 28(3): 264–267.

Lekskul A, Supakitvilekarn T, Padungkiatsagul T, 2018, Outcomes of Undercorrection in Surgical Management and Binocular Vision Gained of Adult Intermittent Exotropia. Clinical Ophthalmology, 12: 1763–1767.

Choi D, Noh H, Park K, et al., 2019, Survival Analysis of Adult and Children Intermittent Exotropia Using a Matched Case-Control Design. Scientific Reports, 9(1): 575.

Yao J, Qu X, Lin J, et al., 2019, Does Successful Surgical Correction of Childhood Large Angle Exotropia in Adults Make Any Difference to Binocularity and Quality of Life? Strabismus, 27(3): 149–155.

Anand K, Baindur S, Dhiman S, et al., 2020, Surgical Outcomes of Plication Versus Resection in Basic Type of Intermittent Exotropia. Canadian Journal of Ophthalmology, 55(4): 323–329.

Lekskul A, Wuthisiri W, Jarupanich N, 2021, A Prospective Study of One-Muscle Surgery in 15–25 Prism Diopters Horizontal Comitant Strabismus in Adults. Clinical Ophthalmology, 15: 3669–3678.

Mattout H, Fouda S, El-Haig W, 2022, Botulinum Toxin Augmented Bilateral Lateral Rectus Recession Versus Three Muscles Surgery in Large-Angle Intermittent Exotropia. International Journal of Ophthalmology, 15(10): 1665–1670.

Narayan A, Dosanjh S, Dominic J, 2023, Early Post-Operative Angle as a Predictor of Surgical Success in Adult Patients with Intermittent Exotropia. Strabismus, 31(2): 152–158.

Srimanan W, Keokajee P, 2025, Early Postoperative Alignment and Preoperative Stereopsis as Determinants of Success in Intermittent Exotropia Surgery. PLOS ONE, 20(10): e0329609.

Wang J, Tibi C, McKeown C, et al., 2026, Surgical Outcomes of Intermittent and Constant Exotropia in an Adult Population Between 18 and 60 Years Old. British Journal of Ophthalmology, 2026 Jan 5: bjo-2025-328132.

Choi S, Kim M, Oh J, 2018, Long-Term Surgical Outcomes of Initial Postoperative Overcorrection in Adults with Intermittent Exotropia. Korean Journal of Ophthalmology, 32(3): 228–233.

Martín-Begué N, Ruiz-Manrique H, Alarcón Martínez M, 2025, Surgical Outcomes and Etiological Considerations in Intermittent Exotropia: A Systematic Narrative Review. Strabismus, online ahead of print.

Hatt S, Leske D, Holmes J, 2012, Comparing Outcome Criteria Performance in Adult Strabismus Surgery. Ophthalmology, 119(9): 1930–1936.

Heo H, Sung M, Park S, 2014, Survival Analysis Following Early Surgical Success in Intermittent Exotropia Surgery. International Journal of Ophthalmology, 7(3): 528–533.