探讨微创单眼外直肌后徙联合内直肌缩短术(R&R)治疗基本型及集合不足型间歇性外斜的临床疗效。

选取2018年3月至2020年8月于北京大学人民医院眼科就诊且进行了微创单眼外直肌后徙联合内直肌缩短术的间歇性外斜视患者113例(113只眼)进行研究。其中，男性48例(48只眼)，女性65例(65只眼)，年龄3~18岁，平均年龄(8.1±3.1)岁。手术前对所有患者进行睫状肌麻痹下验光，根据年龄及屈光状态予以处方配镜，在屈光矫正的前提下检查患者远、近斜视度。根据远、近斜视度之间的关系选择基本型及集合不足型间歇性外斜视患者行微创手术，关键步骤是彻底分离节制韧带及肌间膜，减少眼外肌周围组织粘连。随访6个月以上。手术前后，以近立体视锐度图检查患者近立体视功能，以同视机检查开散性融合功能、集合性融合功能、融合范围、远立体视功能。年龄、病程、斜视度、融合范围、集合性融合及开散性融合等行正态性检验，符合正态分布的连续变量采用±s描述，其手术前后的比较采用配对t检验。性别、近立体视功能及远立体视功能等采用例数及百分比描述。手术前后立体视功能的有无采用卡方检验。

本研究纳入113例(113只眼)患者，平均随访时间0.749年，最短随访6个月，最长随访时间3.5年，根据最后一次随访病例的记录，眼位保持正位的患者有97例(+4 PD~-8 PD)，过矫3例(+6 PD~+8 PD)，欠矫13例(-10 PD~-20 PD)；正位率、欠矫率及过矫率分别为85.8% 、2.7%及11.5%。融合范围均值术前为(14.61±8.43)°，术后为(22.70±5.72)°，两者差异具有统计学意义(t＝-9.726，P<0.05)。有77例患者近立体视锐度值在最后一次随访中达到了40″，占68.1%；有10例患者术前无近立体视的患者在手术后获得近立体视，近立体视锐度值均能保持在40 ″至200 ″范围内，占8.8%。在最后一次复诊中，有68例患者的近立体视功能较前改善，术前范围200″~800″，术后范围60″~400″，占60.18%。有85例患者的远立体视功能有改善，术前范围40″~800″，术后范围40″~400″，占76.6%；有47例患者由无远立体视变为有远立体视，范围60″~800″，占42.3%。手术前后远立体视的有无经χ²检验，其差异无统计学意义(χ²＝1.826，P>0.05)。

微创外直肌后徙联合内直肌缩短术治疗基本型及集合不足型间歇性外斜视手术成功率高，术后患者双眼视功能恢复较好，可作为治疗基本型及集合不足型间歇性外斜视的优选方案。

To observe the outcomes after minimally invasive unilateral recession-resection (R&R) surgery for intermittent exotropia.

The data of 113 patients (113 eyes) who underwent minimally invasive R&R surgery in the Department of Ophthalmology in Peking University People′s Hospital from March 2018 to August 2020 was retrospectively analyzed. Among of them, there were 48 males (48 eyes), and 65 females (65 eyes), with an average age (8.1±3.1) years-old (ranged from 3 to 18 years-old). Before the operation, all patients underwent optometry under ciliary muscle paralysis, and were prescribed glasses according to their age and refractive status, distant and near strabismus were examined under refractive correction. Patients with basic and fusional convergence insufficient intermittent exotropia were selected based on the relationship between near and distant strabismus angle. The core procedure of the minimally invasive operation was to separate and completely resect the check ligaments to reduce adhesions, and the follow-up for more than 6 months. Before and after surgery, patients′ near stereoacuity was measured by a near-stereoscopic sharpness chart, and divergence fusion function, convergence fusion function, fusional range, and distant stereoscopic vision was measured by a synoptophore. The age, disease duration, fusion range, convergent fusion, and divergent fusion were tested for normality, and continuous variables conforming to a normal distribution were described by ±s, and paired t tests were used for pre- and postoperative comparisons. The measurement data such as gender, near stereopsis function, and distant stereopsis function were described by number of cases and percentage. The presence or absence of stereopsis function before and after surgery was tested by Chi-square test.

The average follow-up time for 113 patients was 0.749 years (ranged from 6 months to 3.5 years). After the last follow-up, there were 97 patients (+ 4 PD to -8 PD) with satisfactory outcome, 3 patients with postoperative overcorrection (+ 6 PD to + 8 PD), and 13 patients with undercorrection (- 10 PD to -20 PD). The surgical success, overcorrection and undercorrection rates were 85.8%, 2.7%and 11.5%, 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<0.05). 77(68.1%) patients had a near stereoacuity value of 40″ in the last follow-up. 10 (8.8%) patients who had no near stereoacuity before surgery obtained the function after surgery, and the near stereoacuity values can be maintained in the range of 40″ to 200″. At the last observation, 68 (60.18%) patients had improved near stereopsis compared to before, in the range of 200″ to 800″ before surgery and 60″ to 400″ after surgery. For distance stereoacuity, 85(76.6%) patients showed recovery, in the range of 40″ to 800″ before surgery and 40″ to 400″ after surgery. 47(42.3%) patients who had no distance stereoacuity before surgery developed this function postoperatively, ranges from 60″to 800″. There was not a significant difference regarding the presence or absence of stereoacuity using Chi-square test (χ²=1.826, P>0.05).

Minimally invasive unilateral R&R surgery is effective for treating basic and convergence insufficient intermittent exotropia, which has a high postoperative success rate and good binocular functional recovery.