目的：观察外直肌截除术治疗分开不足的临床效果。

方法：回顾性分析2011-02/2017-10在我院就诊的37例分开不足型患者。临床表现为看远内斜视伴同侧复视，视近为内隐斜视无复视，单眼、双眼运动正常。术前作屈光、斜视度、近立体视、负向融合力检查，然后行单眼或双眼外直肌截除手术。

结果：所有病例术后复视消失，术后1a复查时复视无复发。术前远距内斜视度为+15^△～+28^△(平均18.4^△±5.7^△)，近距内斜视度为+5^△～+16^△(平均10.3^△±3.6^△)，远距近距斜视度差异值为8.1^△±2.3^△； 术后1wk远距斜视度-5.4^△±1.5^△，近距斜视度-7.2^△±1.6^△，差异值为1.8^△±0.6^△； 术后1a远距斜视度-1.9^△±1.2^△，近距斜视度-3.4^△±1.4^△，差异值为1.5^△±0.8^△。术后1wk，1a的远近距斜视度较术前明显减小(P<0.05)，术后1wk，1a的远近距斜视度比较有差异(P<0.05)，患者术前的远近距斜视度之差值与术后1wk，1a的远近距斜视度之差值比较有差异(P<0.05)。术前远距负向融合力为3^△～9^△(平均5.1^△±1.8^△)，近距负向融合力为15^△～24^△(平均19.4^△±3.2^△)。术后1wk远近距负向融合力分别为10.1^△±3.3^△、19.7^△±4.1^△，术后1a远近距负向融合力分别为11.2^△±3.6^△、20.2^△±4.8^△。患者术前与术后1wk的远距负向融合力比较有差异(q=4.551， P=0.013)，术后1wk与术后1a比较无差异(q=0.713，P=0.115)。患者近距融合力术前与术后1wk，1a比较无差异(P>0.05)。

结论：外直肌截除术治疗分开不足可有效降低术后的远近距斜视度差，消除患者的复视症状，改善患者术后的近立体视锐度及远距负向融合力。

METHODS: A retrospective analysis of 37 cases of insufficiency in our hospital from February 2011 to October 2017. The clinical manifestations were hyperopic esotropia with ipsilateral diplopia, myopia implicit esotropia without diplopia, and the monocular and binocular movements were normal. Preoperative refractive, strabismus, near stereopsis, negative fusion force examination, and then single or double external rectus muscle surgery.

RESULTS: Double vision disappeared after all cases, and there was no recurrence in diplopia after one year of follow-up. The preoperative long-term internal strabismus was +15^△-+28^△, with an average of 18.4^△±5.7^△, the near-internal strabismus was +5^△-+16^△, the average was 10.3^△±3.6^△, The difference value of long distance and short distance strabismus was 8.1^△±2.3^△; one week after surgery, the distance strabismus was -5.4^△±1.5^△, the near-distance squint was -7.2^△±1.6^△, the difference value was 1.8^△±0.6^△; the one year postoperative strabismus was -1.9^△±1.2^△, the close squint was -3.4^△±1.4^△, the difference value was 1.5^△±0.8^△. The long-distance strabismus one week after operation and one year after operation was significantly lower than that before operation(P<0.05). The difference of distance and strabismus between one week and one year after operation was statistically significant. Preoperative the difference between near and far squint one week and one year after operation was statistically significant(P<0.05). The difference was statistically significant between the preoperative and postoperative one week. The difference was statistically significant 1 week after surgery and 1 year after surgery. The long-distance negative fusion force before surgery was 3^△-9^△, with an average of 5.1^△±1.8^△, and the near-negative fusion force was 15^△-24^△, with an average of 19.4^△±3.2^△. The long-near negative fusion force was 10.1^△±3.3^△, 19.7^△±4.1^△ at 1wk after operation, and the long-distance negative fusion force was 11.2^△±3.6^△, 20.2^△±4.8^△ for one year after operation. There was a statistically significant difference between the patients with preoperative and one week postoperative negative fusion(q=4.551, P=0.013). There was no significant difference between the one week and one year after surgery(q=0.713, P=0.115).There was no significant difference in the patients' brachytherapy before and after one week and one year after operation(P>0.05).

CONCLUSION: Divergence insufficiency of external rectus muscle surgery can effectively reduce the difference of long-distance strabismus after surgery, eliminate the symptoms of diplopia in patients, and improve the near stereoscopic sharpness and long-distance negative fusion force.