婴幼儿期外斜视的手术时机及远期疗效

Discussion of the optimal timing for surgery in early-onset exotropia and the long-term postoperative effect

目的 探讨婴幼儿期发病的外斜视手术时机及远期疗效.方法 回顾性研究.收集3岁以内发病,外斜视术后随访2年以上的111例患者的临床资料.应用二元logistic回归模型分析可能影响术后眼位及双眼视功能结果的因素,包括发病年龄,手术年龄,斜视类型,术前远、近立体视功能,术后眼位.结果 卡方检验及Spearman相关分析显示：间歇恒定分组与术后远期眼位有关（χ2=4.125,P＜0.05）;间歇恒定分组（χ2=3.951,P＜0.05）及术后眼位（χ2=4.269,P＜0.05）与术后远立体视重建有关;间歇恒定分组与术后近立体视功能重建有关（χ2=6.988,P＜0.01）.经二元logistic回归分析显示：间歇恒定分组与术后远期眼位有关（OR=0.445,P＜0.05）;术前远立体视功能是影响术后远立体视功能恢复的主要因素（OR=10.500,P＜0.01）;术前近立体视、间歇恒定分组与术后近立体视功能重建有关（OR=11.480、0.175,P＜0.05）.结论 婴幼儿期发病的外斜视应在双眼视功能破坏前尽早手术矫正.术前远、近立体视功能的损害和斜视融合控制能力的减弱可以作为判断手术时机的参考指标.

Objective To investigate the optimal timing for surgery in early-onset exotropia （XT） and the long-term postoperative effect.Methods One hundred eleven cases diagnosed with XT before 3 years old who were followed up for at least 2 yearn after surgery were retrospectively analyzed.Logistic regression was used to study the possible factors of the postoperative orthotropia rate and postoperative synoptophore/Titmus stereopsis,such as the age of onset,age at surgery,the type of strabismus,preoperative synoptophore/Titmus stereopsis and postoperative eye position.Results Based on a chi-square test and Spearman correlation analysis,classification of intermittent and constant XT had a statistically significant correlation with the rate of long-term orthotropia （χ2=4.125,P〈0.05）.Classification of intermittent and constant XT （χ2=3.951,P〈0.05） and the postoperative orthotropia （χ2=4.269,P〈0.05） had a statistically significant correlation to postoperative synoptophore stereopsis.Classification of intermittent and constant XT had a statistically significant correlation to postoperative Titmus stereopsis （χ2=6.988,P〈0.01）.Logistic regression analysis showed that the classification of intermittent and constant XT was the main factor affecting the long-term orthotropia rate （OR=0.445,P〈0.05）.Preoperative synoptophore stereopsis was the main factor affecting postoperative synoptophore stereopsis （OR=10.500,P〈0.01）.Preoperative Titmus stereopsis and the classification of intermittent and constant XT were the factors affecting postoperative Titmus stereopsis （OR=11.480,0.175,P〈0.05）.Conclusion It is suggested that patients with early-onset XT undergo surgery before the loss of binocular vision function.The loss of stereopsis function and the loss of the ability to control deviation were indications for exotropia surgery.