To investigate the restoration of near stereopsis following corrective surgery for concomitant exotropia and analyze its influencing factors.

This retrospective case series included 246 patients with concomitant exotropia who underwent strabismus surgery between February 2022 and June 2025. The patients were stratified into a pediatric group (6~<18 years, n=147) and an adult group (≥18 years, n=99). Preoperative and postoperative clinical data were analyzed to assess near stereopsis restoration and its predictors.

A total of 147 pediatric patients with concomitant exotropia were included. The preoperative presence rate of near stereopsis was 83.0%, increasing to 95.9% postoperatively. Postoperative outcomes for near stereoscopic function were cure (60.5%), improvement (19.7%), and no improvement (19.7%). Ninety-nine adult patients with concomitant exotropia were also included. The preoperative presence rate of near stereopsis was 43.4%, increasing to 85.9% postoperatively; Postoperative outcomes were cure (27.3%), improvement (43.4%), and no improvement (29.3%). Near stereoscopic function significantly improved postoperatively in both groups (P<0.001). The postoperative restoration rate was significantly higher in pediatric patients than in adults (80.3% vs 70.7%, χ² = 27.543, P<0.001). Univariate analysis showed that in the pediatric group, age at surgery, type of exotropia, preoperative near stereopsis, preoperative near and distance deviation, surgical approach, and follow-up time were significant predictors (P<0.05). In adults, only the type of exotropia and preoperative near stereopsis were significantly associated with stereopsis restoration (P<0.05). Multivariate logistic regression analysis revealed that preoperative near stereopsis and exotropia type were independent predictors of stereopsis restoration in both groups (P<0.05). Additionally, in pediatric patients, age at surgery, surgical approach, and follow-up time were significant factors, while in adults, age at onset was significant (P<0.05).

Near stereopsis restoration is superior in pediatric patients versus adults. Key determinants differ: pediatric outcomes are influenced by surgical age, approach, follow-up, exotropia type, and preoperative stereopsis; adult outcomes by age at onset, exotropia type, and preoperative stereopsis. These differences should be taken into account in clinical practice.