Yang Min, Chen Jingchang, Shen Tao, Kang Ying, Deng Daming, Lin Xiaoming, Wu Heping, Chen Qiwen, Ye Xuelian, Li Jianqun, Yan Jianhua
From the State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, The People's Republic of China.
Medicine (Baltimore). 2016 Feb;95(5):e2590. doi: 10.1097/MD.0000000000002590.
The clinical characteristics and surgical outcomes in a large sample of patients with intermittent exotropia (IXT) as well as an analysis of risk factors associated with surgical failures are presented in this article. Data from IXT patients who received surgical management at the Eye Hospital, in the Zhongshan Ophthalmic Center, of Sun Yat-Sen University, China from January 2009 to December 2013 were reviewed retrospectively. Included within this analysis were data from pre- and postoperative ocular motility, primary alignment, and binocular vision.A total of 1228 patients with IXT were reviewed. Males (50.4%) and females (49.6%) were nearly equally represented in this sample. Thirty-two patients (2.6%) had a family history of strabismus. The mean age at onset was 6.77 ± 6.43 years (range 7 months -48.5 years), mean duration at presentation was 7.35 ± 6.68 years (range 6 months-47 years), and mean age at surgery was 13.7 ± 8.8 years (range 3-49 years). The mean refractive error was -0.84 ± 2.69 diopter in the right eye and -0.72 ± 2.58 diopter in the left eye. Amblyopia (4.2%), oblique muscle dysfunction (7.0%), and dissociated vertical deviation (4.7%) were also present in these patients. The most common subtype of IXT was the basic type (88.1%). Orthophoria was observed in 80.5% of patients and the ratios of surgical undercorrection and overcorrection were 14.7% and 4.8%, respectively, as determined with a mean follow-up time of 7.8 ± 3.7 months. When combining ocular alignment with binocular vision as the success criteria, the success rate decreased to 35.6%. Multivariate risk factor analysis showed that only the loss of stereoacuity (P = 0.002) was associated with a poor outcome. There were no differences in the long-term results between bilateral lateral rectus recession and unilateral lateral rectus recession with medial rectus resection.Most IXT patients displayed normal vision, with few having positive family histories, amblyopia, oblique muscle dysfunction, and dissociated vertical deviation. The most common subtype of IXT was the basic type. Long-term surgical results were less favorable when sensory status was included in the criteria for success. Patients with stereoacuity loss were at an increased risk for poor outcomes.
本文介绍了大量间歇性外斜视（IXT）患者的临床特征和手术结果，并分析了与手术失败相关的危险因素。回顾性分析了2009年1月至2013年12月在中国中山大学中山眼科中心眼科医院接受手术治疗的IXT患者的数据。该分析包括术前和术后眼球运动、初始眼位矫正和双眼视功能的数据。
共回顾了1228例IXT患者。样本中男性（50.4%）和女性（49.6%）的比例几乎相等。32例患者（2.6%）有斜视家族史。平均发病年龄为6.77±6.43岁（范围7个月至48.5岁），平均就诊时病程为7.35±6.68岁（范围6个月至47岁），平均手术年龄为13.7±8.8岁（范围3至49岁）。右眼平均屈光不正为-0.84±2.69屈光度，左眼为-0.72±2.58屈光度。这些患者中还存在弱视（4.2%）、斜肌功能障碍（7.0%）和分离性垂直偏斜（4.7%）。IXT最常见亚型为基本型（88.1%）。80.5%的患者初始眼位矫正为正位，平均随访时间7.8±3.7个月，手术欠矫和过矫的比例分别为14.7%和4.8%。当将眼位矫正和双眼视功能结合作为成功标准时，成功率降至35.6%。多因素危险因素分析显示，只有立体视锐度丧失（P=0.002）与不良预后相关。双侧外直肌后徙术和单侧外直肌后徙联合内直肌切除术的长期结果无差异。
大多数IXT患者视力正常，有斜视家族史、弱视、斜肌功能障碍和分离性垂直偏斜的患者较少。IXT最常见亚型为基本型。当将感觉功能状态纳入成功标准时，长期手术结果不太理想。立体视锐度丧失的患者预后不良风险增加。
