Purpose: We intended to investigate the clinical features and success rates of surgery in premature children with exotropia. Methods: Twenty-two exotropia children with a gestational age of less than 37 weeks, or a birth weight of less than 2,000 g were included. The children had also been clinically observed for at least six months after surgery for exotropia. This study analyzed the results of their surgery in terms of gestational age, birth weight, ages at the first examination, and surgery,

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... visual acuity, the angle of exodeviation at the first examination and the maximum angle of exodeviation before surgery, the frequency of accompanied strabismus, and surgical results. Surgical success was defined as postoperative angle of deviation less than 10 PD. The patients were divided into success and failure groups, and a comparative analysis was performed between the 2 groups. Results: The mean maximum angle of exodeviation before surgery was 28.4 ± 8.2 PD at far distance and 28.5 ± 8.3 PD at near distance. The mean angle of exodeviation at last visit after surgery was decreased to 8.0 ± 14.2 PD at far distance and 9.1 ± 14.8 PD at near distance. The success rate of surgery was measured to be 59.1% at the last visit. Recurrence was a major cause of failure, which occurred in eight cases (36.4%). The angle of exodeviation at the first examination and the maximum angle of exodeviation in the failure group were higher than in the success group with statistical significance. The incidence of vertical strabismus before or after the surgery was 45.6% (10 cases) and there was no statistically significant difference between the 2 groups. Conclusions: The premature children with exotropia had a relatively low surgical success rate and the major cause of the surgical failure was the recurrence of exotropia. The degree of the angle of deviation at the first examination and the maximum angle of exodeviation before surgery was an influential factor on the surgical results. J Korean Ophthalmol Soc 2015;56(2):241-248