目的

探讨采用不同方法测量急性共同性内斜视（AACE）手术目标斜视角的差异以及手术方式的选择。

方法

收集2022年9月至2023年12月在山东中医药大学附属眼科医院行斜视矫正术的连续性AACE患者39例（56只眼）。其中，男性32例（46只眼）、女性7例（10只眼）；年龄5～50岁；平均年龄（18.7±11.2）岁。术前斜视角测量均采用三棱镜交替遮盖试验（PACT）、马氏杆加三棱镜法（MRPT）、base-out恢复点（BORP）和三棱镜适应试验（PAT）4种方法，并以视远和视近最大斜视角的平均值作为手术目标量。采用单眼或双眼内直肌后退（MRc）术或内直肌后退联合外直肌缩短（RR）术。分析不同方法测量斜视角的差异以及不同术式手术效果的差异。手术成功标准为视远和视近斜视角均≤±8^△且复视消失。等效球镜和斜视度采用正态性检验，采用±s或M（Q1，Q3）表示，比较采用t检验或Wilcoxon秩和检验；术前4种方法测量斜视角的比较采用单因素重复测量方差分析，当差异有统计学意义时，进一步两两比较；Ⅱ型和Ⅲ型AACE患者术前斜视角增量的比较采用成组t检验；MRc术和RR术的实际手术增量之间的比较采用成组t检验。手术前后融合功能比较采用配对t检验或Wilcoxon秩和检验。计数资料采用频数和百分比表示，组间比较采用χ²检验。

结果

术前PACT测量视远和视近斜视角分别为（33.5±12.4）^△和（34.6±15.6）^△。MRPT测量视远斜视角较PACT增大（6.6±4.6）^△，差异有统计学意义（t＝2.11，P＜0.05）；视近斜视角增大（5.4±4.3）^△，差异无统计学意义（t＝1.38，P＞0.05）。BORP测量斜视角与PACT视远差值和视近差值分别为（12.5±7.4）^△和（16.9±11.6）^△，差异均有统计学意义（t＝4.31，4.00；P＜0.05）。PAT测量斜视角与PACT视远差值和视近差值分别为（11.8±7.8）^△和（16.5±11.1）^△，差异均有统计学意义（t＝3.78，4.23；P＜0.05）。BORP与PAT测量视远或视近斜视角比较差异均无统计学意义（t＝0.22，0.08；P＞0.05）。PAT平均用时（11.1±4.1）h。所有患者均获得单次手术成功。与PACT对应的理论手术量相比，MRc术和RR术的实际手术量分别增加（3.4±1.5）mm和（2.8±2.3）mm，差异无统计学意义（t＝-0.91，P＞0.05）；与BORP或PAT对应的理论手术量相比，MRc术和RR术的实际手术量分别增加（0.8±1.4）mm和（0.04±0.4）mm，差异有统计学意义（t＝-2.87，P＜0.05）。

结论

BORP和PAT可能具有同等暴露AACE患者最大斜视角的作用，作为手术目标量能有效治疗AACE。AACE手术采用RR术式较MRc术式的手术调整量更少。

Objective

To investigate the difference of surgical target angles measured by different methods and the selection of surgical procedure in acute acquired comitant esotropia（AACE）.

Methods

Thirty-nine consecutive AACE patients（56 eyes）underwent surgery at the Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine from September 2022 to September 2023 were collected.Among of them，there were 32 males（46 eyes）and 7 famles（10 eyes）with an averange of（18.7±11.2）years-old（ranging from 5 to 50 years-old）.Four methods were used to measure the preoperative angle of deviation，including the prism and alternative cover test（PACT），the maddox rod and prism test（MRPT），the baseout recovery point（BORP）and the prism adaptation test（PAT）.The average value of the maximum angles at distance and near was used as the surgical target angle.The surgical method was the unilateral or bilateral medial rectus recession（MRc）procedure or the recession and resection（RR）procedure.The difference in angles measured by different methods and the effect of different surgical procedures were analyzed.A successful surgical alignment was defined as the distance and near angle within±8^△with no diplopia.The equivalent spherical lens and deviation were performed with normality test and described by±s or M（Q1，Q3），and compared by t-test or Wilcoxon rank sum test.The comparison of preoperative four methods for measuring oblique angle was conducted using ANOVA.When the difference was statistically significant，further pairwise comparisons were made.The comparison of preoperative oblique angle increment between typeⅡand typeⅢAACE patients was conducted using a grouped t-test.The comparison between the actual surgical increments of MRC and RR procedures was conducted using a grouped t-test.The comparison of fusion function before and after surgery was conducted using paired t-test or Wilcoxon rank sum test.Count data was expressed in frequency and percentage，and comparison between groups was performed using the chi square test.

Results

The mean preoperative angles measured by PACT at distance and near were（33.5±12.4）^△and（34.6±15.6）^△，respectively.The augmentation of the angle at distance measured by MRPT was（6.6±4.6）^△，and the difference was statistically significant（t＝2.11，P＜0.05）.The augmentation of the angle at near measured by MRPT was（5.4±4.3）^△with no statistically significant difference（t＝1.38，P＞0.05）.The angle measured by BORPwas larger than that measured by PACT the augmentation at distance and at near were（12.5±7.4）^△，（16.9±11.6）^△，respectively.There were significant differences between them（t＝4.00，4.31；P＜0.05）.The angle measured by PAT was larger than that measured by PACT the augmentation at distance and at near were（11.8±7.8）^△，（16.5±11.1）^△，respectively.There were significant differences between them（t＝3.78，4.23；P＜0.05）.There was no significant difference between angles measured by BORP and PAT at distance or at near（t＝0.22，0.08；P＞0.05）.The average time of PAT was（11.1±4.1）hours.All patients achieved successful surgical alignment after one surgery.The actual augmentation of the surgical amount of MRc and RR procedures based on the PACTwas（3.4±1.5）mm and（2.8±2.3）mm，respectively，with no statistical significance（t＝-0.91，P＞0.05）.The actual augmentation of the surgical amount of MRc and RR procedures based on the BORP or PAT was（0.8±1.4）mm and（0.04±0.4）mm，respectively，and the difference was statistically significant（t＝-2.87，P＜0.05）.

Conclusions

The BORP and PAT may have equivalent effect to uncover the latent angle of AACE fully，and can effectively treat AACE as the surgical target angle.The RR procedure presented superiority with less surgical augmentation than the MRc procedure in AACE surgery.