{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T07:56:06Z","timestamp":1777881366596,"version":"3.51.4"},"reference-count":38,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Ophthalmol Eye Dis"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>To compare the preoperative clinical features in patients with basic unilateral exotropia who underwent single versus two and three or more strabismus surgeries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design:<\/jats:title>\n                    <jats:p>retrospective<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method:<\/jats:title>\n                    <jats:p>Two thousand four hundred fifty-seven patients with unilateral basic exotropia were recruited over 10\u2009years. Of these, 1886 (76.8%) had one surgery, 411 (16.7%) had two, and 160 (6.5%) had three or more surgical interventions. Preoperative data included the best corrected distance visual acuity (BCVA), refractive error, magnitude of exotropia, and amblyopia type and severity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The mean age at first surgery was 26.3\u2009\u00b1\u200913.35\u2009years (age range: 2\u201377) with no significant difference between groups with one, two, and three or more surgeries (\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.770). Mean BCVA in the strabismic eye was significantly worse in patients who underwent three or more surgeries (0.82\u2009\u00b1\u20090.076 logMAR) than those who had one (0.55\u2009\u00b1\u20090.018 logMAR;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) or two surgeries (0.52\u2009\u00b1\u20090.038 logMAR;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Spherical equivalent refraction in the strabismic eye was significantly more hyperopic in patients who underwent three or more surgeries (0.79\u2009\u00b1\u20090.37 D), compared with those with one (\u22120.95\u2009\u00b1\u20090.094 D;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001) or two surgeries (\u22120.36\u2009\u00b1\u20090.16 D;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u20090.001). Relative to one surgery, undergoing two surgeries was independently associated with larger distance horizontal deviation (adjusted odds ratio (aOR) per prism diopter\u2009=\u20091.012; 95% CI, 1.003\u20131.022;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.009). Undergoing three or more surgeries was independently associated with amblyopia severity (aOR\u2009=\u20092.368; 95% CI, 1.279\u20134.384;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009=\u20090.006); in the strabismic eye, and higher spherical power markedly increased the odds (aOR\u2009=\u200913.553; 95% CI, 12.801\u201314.348;\n                      <jats:italic toggle=\"yes\">p<\/jats:italic>\n                      \u2009&lt;\u2009.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Worse preoperative BCVA, greater hyperopia, and higher angle of deviation were associated with a greater likelihood of requiring more than one surgery. Surgeons should optimize preoperative refractive and amblyopia management and counsel high-risk patients about the increased likelihood of additional procedures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/25158414251407867","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T07:25:10Z","timestamp":1767597910000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative factors associated with multiple strabismus surgeries in basic exotropia"],"prefix":"10.1177","volume":"18","author":[{"given":"Mohammad Reza","family":"Akbari","sequence":"first","affiliation":[{"name":"Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Babak","family":"Masoomian","sequence":"additional","affiliation":[{"name":"Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arash","family":"Mirmohammadsadeghi","sequence":"additional","affiliation":[{"name":"Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2386-1730","authenticated-orcid":false,"given":"Elham","family":"Azizi","sequence":"additional","affiliation":[{"name":"Department of Optometry and Vision Sciences, University of Melbourne, Melbourne, VIC, Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hayder Resen","family":"Hussain","sequence":"additional","affiliation":[{"name":"School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8270-9704","authenticated-orcid":false,"given":"Masoud","family":"Khorrami-Nejad","sequence":"additional","affiliation":[{"name":"School of Rehabilitation, Tehran University of Medical Sciences, Enghelab St, Tehran 1148965111, Iran"},{"name":"Translational Ophthalmology Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"179","published-online":{"date-parts":[[2026,1,4]]},"reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1038\/eye.1994.158"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2004.07.033"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.ophtha.2003.04.001"},{"key":"e_1_3_4_5_2","unstructured":"Intermittent exotropia; a major review [press release]. 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