To evaluate the surgical result of patients who had intermittent or constant +3.00 diopter (D) or more exotropia and hyperopia.

Twenty-seven patients who had an operation for +3.00 D or more hyperopia and exotropia were included. The duration of follow-up was 6 months or more after surgery. Age at the initial visit, visual acuity, refractive errors, presence of amblyopia, reduced rate of hyperopic correction, changes in exodeviated angle after reduction of hyperopic correction, surgical results and postoperative data were analyzed.

The mean age at the initial visit was 5.4 years and at surgery was 7.3 years. The mean degree of hyperopia in the worse eye was 3.86 ± 1.35 D and the better eye 1.31 ± 1.19 D. Fourteen of the 27 patients had amblyopia. The degree of reduced hyperopia correction was 1.35 ± 1.06 D during the preoperative period. The initial angles of deviation were 26.8 ± 7.7 prism diopters (PD) at distance and 28.2 ± 8.9 PD at near. At postoperative 12 months, 19 of 27 patients (70.4%) achieved deviated angle within 10 PD. The cause of surgical failure was recurrence of exotropia. All the surgically failed patients had reduced hyperopic correction of the better eye before surgery. Reduction rate of hyperopic correction in the surgically failed group was significantly higher than in the surgically successful group ( p = 0.004).

There was a high incidence of amblyopia in the patients with +3.00 D or more exotropia and hyperopia before surgery. The cause of surgical failure was the recurrence of exotropia, and the degree of reduced hyperopic correction in the surgically failed group was larger than in the surgically successful group.