目的：观察直肌边缘切开术治疗不同类型外斜视术后双眼视觉的变化。

方法：将外斜视患者59例根据斜视类型分三组：间歇性外斜视组(组1)为27例、恒定性外斜视组(组2)为21例及外斜V征组(组3)为11例。手术前后用同视机检查双眼视觉三级功能。随访6mo，记录数据并分析。

结果：各组双眼视觉的比较：(1)术后Ⅰ级同时视功能：术后1mo，组1(22例，81%)同时视的恢复优于组2(11例，52%)及组3(5例，46%)(P<0.05)。(2)术后II级融合功能：术后1、3、6mo，三组融合功能均有差异(P<0.05)。术后6mo组1间歇性外斜视(20例，74%)融合功能的恢复优于组2恒定性外斜视(9例，43%)及组3外斜V征(4例，36%)。术后6mo组1(17.15°±9.19°)融合范围显著大于组2(9.00°±8.64°)(P=0.004)。(3)术后III级远立体视：组1(9例，33%)术后远立体视的恢复较好，但三组术后远立体视的恢复无明显差异(P>0.05)，且恢复时间较长。(4)直肌边缘切开术后患者双眼视觉三级功能的恢复明显优于术前(P<0.001)。且术后1mo恢复较为稳定。

结论：直肌边缘切开术治疗斜视安全有效，且术后双眼视觉功能较术前均有明显改善，在术后1mo左右双眼视觉恢复基本稳定。间歇性外斜视双眼视觉功能的恢复优于恒定性外斜视以及外斜V征，而恒定性外斜视及外斜V征对术后双眼视觉恢复的影响一致，因此手术时机选择应考虑斜视类型，更有效地恢复和重建双眼视觉。

METHODS: We selected 59 patients for case study and divided them into three groups by types of exotropia. Intermittent exotropia 27 cases is Group 1; Constant exotropia 21 cases is Group 2; V-pattern exotropia 11 cases is Group 3. We examined their three-degree visual functions via synoptophore preoperative and postoperative respectively. We recorded the examination data and conducted in-depth analysis after 6mo follow-up.

RESULTS: Comparison on binocular vision improvement of different types of exotropia. 1)Postoperative level Ⅰ simultaneous perception: at 1 mo postoperative, visual recovery in Group 1(22 cases, 81%)was better than that in Group 2(11 cases, 52%)and Group 3(5 cases, 46%). The difference was statistically significant(P<0.05); 2)Postoperative level Ⅱ fusion: at 1mo, 3mo and 6mo postoperative, there were significant differences in fusion function among the three groups(P<0.05). The recovery of fusion function in Group 1(20 cases, 74%)was better than that in Group 2(9 cases, 43%)and Group 3(4 cases, 36%)at 6mo. The fusion range of Group 1(17.15°±9.19°)was significantly larger than that of Group 2(9.00°±8.64°), and the difference was statistically significant(P=0.004); 3)Postoperative level Ⅲ distance stereoacuity: distance stereoacuity recovery of Group 1(9 cases, 33%)were again proved to be better than others. However, no statistical difference was found in the Ⅲ vision function between three groups(P>0.05); 4)Three-degree visual function had obvious improvement after marginal myotomy. The differences were statistically significant(P<0.001). The recovery was stable in 1mo postoperative.

CONCLUSION: Marginal myotomy can reduce intraoperative complications and traction of extraocular muscle, and improve surgical safety. There was significant improvement of three-degree visual function after marginal myotomy, and the recovery of binocular vision became stable 1mo postoperative. The binocular vision recovery of the intermittent exotropia patients was supreme to the constant exotropia patients and V-pattern exotropia patients. Constant exotropia and V-pattern exotropia had the same impact on the recovery of binocular vision. Thus, types of exotropia should be considered when deciding surgery timing, in order to achieve more effective recovery and to rebuild binocular vision.