The stability of horizontal ocular alignment of triad exotropia after one-step triple surgery

Purpose A-pattern exotropia, superior oblique muscle overaction, and dissociated vertical deviation may coexist and are referred to as triad exotropia. The present study evaluated the postoperative stability of horizontal ocular alignment of triad exotropia and possible prognostic factors. Methods Medical records of patients with triad exotropia who had one-step triple surgery of superior oblique muscle weakening, superior rectus muscle recession, and lateral rectus muscle recession were reviewed. The horizontal alignment and postoperative drift of triad exotropia were analyzed and compared with constant exotropia. Results The triad exotropia showed a mean of 7.7 △ (± 8.5 △ ) eso-drift, while the constant exotropia was (3.5 △ ± 3.4 △ ) exo-drift. Multiple linear regression analysis showed that the degree of superior oblique muscle overaction after surgery ( P = 0.011) was the only factor associated with horizontal drift. Patients with superior oblique muscle underaction showed larger eso-drift when compared to patients without superior oblique muscle underaction (− 18.0 △ ± 11.1 △ vs. − 5.1 △ ± 5.7 △ ; P = 0.024). The final success rates of the triad exotropia and constant exotropia groups were 53.3% and 69.2%, respectively, and the overcorrection rates were 26.7% and 2.6% ( P = 0.035). Conclusions An overall trend of eso-drift in primary position occurred in triad exotropia after triple surgery up to a follow-up of 25 months. Patients presenting superior oblique muscle underaction after surgery seemed to have large angles of eso-drift, which might be taken into account in surgical planning and follow-up.