{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:50:07Z","timestamp":1782121807735,"version":"3.54.5"},"reference-count":36,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Br J Ophthalmol"],"accepted":{"date-parts":[[2025,12,16]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Comitant exotropia in adults poses distinct surgical challenges and has been less extensively studied compared with paediatric cases. Evaluating surgical outcomes in this population can inform treatment approaches and help establish realistic expectations for patients and clinicians.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Retrospective chart review of adults 18\u201360 years old who underwent surgery for comitant exotropia between 2014 and 2024 at a single institution. Patients were classified as intermittent (X(T)) or constant exotropia (XT) and divided into three groups: basic exotropia (BXT), divergence excess (DEXT) and convergence insufficiency (CIXT). Surgical motor success was defined as a postoperative deviation\u226410 prism dioptres (PDs) and sensory success as resolution of diplopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>165 patients (mean age 38.2\u00b112.1 years, 50.3% male) were included. The mean preoperative deviation was 44.8\u00b117.5\u2009PD at distance and 48.3\u00b120.1\u2009PD at near. After initial surgery, the overall motor success was 62.4%, highest in BXT (69.4%), followed by CIXT (52.8%) and DEXT (50%) (p=0.08). Motor success was significantly higher in X(T) than XT (69.2% vs 52.2%, p=0.026), and in cases with adjustable sutures rather than non-adjustable (p=0.033), however, similar in unilateral recess-resect and bilateral lateral rectus recessions (62.7% vs 59.1%, p=0.81). Preoperative diplopia was present in 28.5% (47\/165) and resolved in 89.4% (42\/47). The final motor success was 66.7% after a second surgery in nine patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The motor outcomes in adults are comparable to those reported in children. Higher motor success is found in X(T) and with the use of adjustable sutures. Surgical intervention provides relief of diplopia and meaningful gains in stereopsis.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bjo-2025-328132","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T18:20:20Z","timestamp":1767637220000},"page":"751-758","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Surgical outcomes of intermittent and constant exotropia in an adult population between 18 and 60 years old"],"prefix":"10.1136","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8958-6893","authenticated-orcid":false,"given":"Jiaxing","family":"Wang","sequence":"first","affiliation":[{"name":"University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Tibi","sequence":"additional","affiliation":[{"name":"University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig","family":"McKeown","sequence":"additional","affiliation":[{"name":"University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hilda","family":"Cap\u00f3","sequence":"additional","affiliation":[{"name":"University of Miami Health System Bascom Palmer Eye Institute, Miami, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,5]]},"reference":[{"key":"2026062202151374000_110.7.751.1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(65)93991-7"},{"key":"2026062202151374000_110.7.751.2","doi-asserted-by":"publisher","DOI":"10.1001\/archopht.116.3.324"},{"key":"2026062202151374000_110.7.751.3","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.ophtha.2023.09.004","article-title":"Eight-Year Outcomes of Bilateral Lateral Rectus Recessions versus Unilateral Recession-Resection in Childhood Basic-Type Intermittent Exotropia","volume":"131","author":"Donahue","year":"2024","journal-title":"Ophthalmology"},{"key":"2026062202151374000_110.7.751.4","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1016\/j.ophtha.2018.08.034","article-title":"A Randomized Trial Comparing Bilateral Lateral Rectus Recession versus Unilateral Recess and Resect for Basic-Type Intermittent Exotropia","volume":"126","author":"Donahue","year":"2019","journal-title":"Ophthalmology"},{"key":"2026062202151374000_110.7.751.5","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1016\/j.jaapos.2016.08.011","article-title":"Factors associated with surgical success in adult patients with exotropia","volume":"20","author":"Jung","year":"2016","journal-title":"J AAPOS"},{"key":"2026062202151374000_110.7.751.6","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1038\/s41598-018-38160-8","article-title":"Survival analysis of adult and children intermittent exotropia using a matched case-control design","volume":"9","author":"Choi","year":"2019","journal-title":"Sci Rep"},{"key":"2026062202151374000_110.7.751.7","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1038\/sj.eye.6700347","article-title":"Surgical correction of large-angle exotropia in adults","volume":"17","author":"Currie","year":"2003","journal-title":"Eye (Lond)"},{"key":"2026062202151374000_110.7.751.8","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.2147\/OPTH.S324517","article-title":"A Prospective Study of One-Muscle Surgery in 15-25 Prism Diopters Horizontal Comitant Strabismus in Adults","volume":"15","author":"Lekskul","year":"2021","journal-title":"Clin Ophthalmol"},{"key":"2026062202151374000_110.7.751.9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2023.12.007"},{"key":"2026062202151374000_110.7.751.10","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2012.02.035"},{"key":"2026062202151374000_110.7.751.11","doi-asserted-by":"publisher","DOI":"10.3928\/15428877-20100430-10"},{"key":"2026062202151374000_110.7.751.12","doi-asserted-by":"crossref","first-page":"19383","DOI":"10.1038\/s41598-021-98801-3","article-title":"Long term surgical outcomes of unilateral recession-resection versus bilateral lateral rectus recession in basic-type intermittent exotropia in children","volume":"11","author":"Kim","year":"2021","journal-title":"Sci Rep"},{"key":"2026062202151374000_110.7.751.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.01.004"},{"key":"2026062202151374000_110.7.751.14","doi-asserted-by":"crossref","first-page":"693","DOI":"10.1038\/eye.2017.259","article-title":"Surgical outcomes of three different surgical techniques for treatment of convergence insufficiency intermittent exotropia","volume":"32","author":"Farid","year":"2018","journal-title":"Eye (Lond)"},{"key":"2026062202151374000_110.7.751.15","doi-asserted-by":"publisher","DOI":"10.1136\/bjophthalmol-2013-304442"},{"key":"2026062202151374000_110.7.751.16","doi-asserted-by":"crossref","first-page":"3558","DOI":"10.4103\/IJO.IJO_2977_22","article-title":"Surgical outcomes of bilateral lateral rectus recession versus unilateral recession and resection for the divergence excess type of intermittent exotropia","volume":"71","author":"Han","year":"2023","journal-title":"Indian J Ophthalmol"},{"key":"2026062202151374000_110.7.751.17","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0214478","article-title":"Surgical outcomes of intermittent exotropia according to exotropia type based on distance\/near differences","volume":"14","author":"Bae","year":"2019","journal-title":"PLoS ONE"},{"key":"2026062202151374000_110.7.751.18","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1186\/s12886-024-03812-z","article-title":"Clinical features in patients with acquired intermittent and constant exotropia who underwent surgery","volume":"24","author":"Akbari","year":"2024","journal-title":"BMC Ophthalmol"},{"key":"2026062202151374000_110.7.751.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2022.08.027"},{"key":"2026062202151374000_110.7.751.20","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2006.06.045"},{"key":"2026062202151374000_110.7.751.21","article-title":"Interventions for intermittent exotropia","volume":"2021","author":"Pang","year":"2021","journal-title":"Cochrane Database Syst Rev"},{"key":"2026062202151374000_110.7.751.22","first-page":"704","article-title":"Strabismus reoperation techniques","volume":"79","author":"Jampolsky","year":"1975","journal-title":"Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol"},{"key":"2026062202151374000_110.7.751.23","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9394(79)90641-X"},{"key":"2026062202151374000_110.7.751.24","doi-asserted-by":"crossref","first-page":"100","DOI":"10.1016\/j.ophtha.2021.07.026","article-title":"Adjustable Sutures in the Treatment of Strabismus: A Report by the American Academy of Ophthalmology","volume":"129","author":"Heidary","year":"2022","journal-title":"Ophthalmology"},{"key":"2026062202151374000_110.7.751.25","doi-asserted-by":"crossref","first-page":"1028","DOI":"10.1016\/j.ophtha.2022.04.021","article-title":"Adjustable Suture Technique Is Associated with Fewer Strabismus Reoperations in the Intelligent Research in Sight Registry","volume":"129","author":"Oke","year":"2022","journal-title":"Ophthalmology"},{"key":"2026062202151374000_110.7.751.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2011.08.025"},{"key":"2026062202151374000_110.7.751.27","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/j.ajo.2024.06.012","article-title":"Characteristics and Surgical Outcomes of Comitant Esotropia in an Adult Population Between 18 and 60 Years Old","volume":"267","author":"Cavuoto","year":"2024","journal-title":"Am J Ophthalmol"},{"key":"2026062202151374000_110.7.751.28","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2007.04.022"},{"key":"2026062202151374000_110.7.751.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajo.2007.06.011"},{"key":"2026062202151374000_110.7.751.30","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1016\/j.jaapos.2019.07.005","article-title":"Diplopia after strabismus surgery for adults with nondiplopic childhood-onset strabismus","volume":"23","author":"Wang","year":"2019","journal-title":"J AAPOS"},{"key":"2026062202151374000_110.7.751.31","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1080\/02713683.2023.2255396","article-title":"Refractive Profile of Surgical Patients with Intermittent Exotropia: A Large-Sample Cross-Sectional Study in Southern China","volume":"48","author":"Wen","year":"2023","journal-title":"Curr Eye Res"},{"key":"2026062202151374000_110.7.751.32","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2021.07.012"},{"key":"2026062202151374000_110.7.751.33","doi-asserted-by":"crossref","DOI":"10.1038\/srep35177","article-title":"Refractive Errors and Concomitant Strabismus: A Systematic Review and Meta-analysis","volume":"6","author":"Tang","year":"2016","journal-title":"Sci Rep"},{"key":"2026062202151374000_110.7.751.34","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-012-1991-y"},{"key":"2026062202151374000_110.7.751.35","doi-asserted-by":"crossref","first-page":"1314","DOI":"10.1038\/s41433-019-0419-x","article-title":"Surgical and sensory outcomes in patients with intermittent exotropia according to preoperative refractive error","volume":"33","author":"Ahn","year":"2019","journal-title":"Eye (Lond)"},{"key":"2026062202151374000_110.7.751.36","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaapos.2003.08.006"}],"container-title":["British Journal of Ophthalmology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bjo-2025-328132","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T09:16:27Z","timestamp":1782119787000},"score":1,"resource":{"primary":{"URL":"https:\/\/bjo.bmj.com\/lookup\/doi\/10.1136\/bjo-2025-328132"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,5]]},"references-count":36,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,6,22]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bjo-2025-328132"],"URL":"https:\/\/doi.org\/10.1136\/bjo-2025-328132","relation":{},"ISSN":["0007-1161","1468-2079"],"issn-type":[{"value":"0007-1161","type":"print"},{"value":"1468-2079","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,5]]}}}