摘要目的:探讨单侧内直肌缩短术和内、外直肌探查并再次外直肌后徙联合内直肌缩短术治疗残余性和复发性外斜视的临床效果。方法:回顾性病例对照研究。分析徐州市第一人民医院2019年1月至2022年3月因残余性和复发性外斜视行再次手术的49例(49眼)临床资料。根据手术方式分为两组，A组23例(23眼)行单侧内直肌缩短术；B组26例(26眼)行内外直肌探查并再次外直肌后徙联合内直肌缩短术。观察术后1 d、1、3及6个月各时间点的斜视度、双眼单视功能、眼位、眼球运动及并发症情况。结果:斜视度：手术后各时间点A、B两组的斜视度绝对值较术前均明显降低( F时间＝473.09， P时间<0.001； F组间＝0.59， P组间＝0.447； F组间×时间＝0.90， P组间×时间＝0.350)。双眼单视功能：术后6个月与术前比较，A组的差异无统计学意义( χ2＝0.91， P＝0.635)，B组的差异无统计学意义( χ2＝1.69， P＝0.431)；术后6个月两组间的比较差异无统计学意义( χ2＝0.45， P＝0.798)。正位率：术后6个月A组为91.30% (21/23)，B组为92.30%(24/26)，差异无统计学意义( χ2＝1.36， P＝0.508)。末次随访两组均无眼球运动受限、眼球运动非共同性或眼前段缺血等并发症的发生。 结论:单侧内直肌缩短术和内、外直肌探查并再次外直肌后徙联合内直肌缩短术均是治疗残余性和复发性外斜视的有效方法。

abstractsObjective:To investigate the clinical efficacy of unilateral medial rectus resection or medial and lateral rectus exploration plus lateral rectus re-recession and medial rectus re-resection in the treatment for residual and recurrent exotropia.Methods:This was a retrospective case control study. The data of 49 eyes of 49 patients with residual and recurrent exotropia who underwent reoperation from Jan. 2019 to Mar. 2022 in the Xuzhou First People’s Hospital were retrospectively analyzed. They were divided into two groups based on the operation method. In group A, 23 eyes of 23 patients received unilateral medial rectus resection. In group B, 26 eyes of 26 patients received medial and lateral rectus exploration plus lateral rectus re-recession and medial rectus re-resection. The exotropia deviation, binocular visual function, eye position, eye movement and complications were observed at 1 day, 1, 3 and 6 months after operation.Results:Exotropia deviation at each time point after operation: the absolute value of exotropia deviation decreased significantly compared with that before operation in both group A and B ( Ftime=473.09, Ptime<0.001; Fgroup=0.59, Pgroup=0.447; Fgroup× time=0.90, Pgroup× time=0.350). Binocular visual functions at 6 months after operation compared with preoperation, there was no significant difference in group A ( χ2=0.91, P=0.635), and no significant difference in group B ( χ2=1.69, P=0.431). There was no significant difference between group A and group B at 6 months after operation ( χ2=0.45, P=0.798). The correct position rate at 6 months after operation, group A showed a correct rate of 91.30%(21/23), while that of group B was 92.30%(24/26). The difference between the two groups was not statistically significant ( χ2=1.36, P=0.508). No patients presented with limited ocular motility, lateral incomitance, or anterior segment ischemia. Conclusion:For residual and recurrent exotropia, unilateral medial rectus resection or medial and lateral rectus exploration plus lateral rectus re-recession and medial rectus re-resection are both effective treatments.