BACKGROUND: To observe the outcomes after minimally invasive, small-incision unilateral recession-resection (R&R) surgery and to establish an artificial intelligence (AI)-based operation design predictive model for modified strabismus surgery.METHODS: Basic intermittent exotropia (IXT) patients with an exodeviation angle between 20 and 85 prism diopters underwent the modified R&R surgery. The core procedure of the operation is to separate and completely resect the check ligaments. After at

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... six months of follow-up, the exodeviation angle, postoperative success rate, pre- and postoperative fusional function and change in stereopsis were observed retrospectively. The predictive model was established based on the successful cases; 38 related factors were entered into the model. The machine learning algorithm LightGBM was used to train the model.RESULTS: In all, 113 patients were included: 48 males and 65 females. The average follow-up time was 0.749 years. The surgical success, overcorrection and undercorrection rates were 85.8% (97/113), 2.7% (3/113) and 11.5% (13/113), respectively. There was a significant improvement in the fusional range from 14.61±8.43° preoperatively to 22.70±5.72° postoperatively (t=-9.726, P<0.001).Near stereoacuity improved more than 60% postoperatively. For distance stereoacuity, 47 (41.59%) patients showed recovery, with no significant difference regarding the presence or absence of stereoacuity (chi-square test, c2=3.762, P>0.05). The AI-based operation design predictive model was preliminarily established; the accuracy reached 95%.CONCLUSION: Minimally invasive, small-incision unilateral R&R surgery is effective for treating basic IXT, with a high postoperative success rate and good binocular functional recovery. This could be a better surgical design for treating basic IXT. A preliminary AI predictive model based on this operation was established.