目的：探讨A型肉毒毒素(BTA)注射和眼外肌手术治疗大角度(≥+60 PD)急性共同性内斜视(AACE)的疗效差异性。

方法：回顾性分析2020-06/2022-12于我院治疗的AACE患者60例的临床资料，根据治疗方式分为2.5 IU BTA注射组(14例)、5.0 IU BTA注射组(29例)、手术组(17例)。治疗后随访6 mo，观察纳入患者屈光矫正后的斜视度、视功能、治疗有效率及BTA注射后并发症发生情况。

结果：治疗后6 mo，手术组和5.0 IU BTA注射组患者的斜视度均小于2.5 IU BTA注射组(P<0.017)，但手术组与5.0 IU BTA注射组患者的斜视度无显著差异(P>0.017)； 5.0 IU BTA注射组有效率高于2.5 IU BTA注射组(86% vs 43%，P<0.017)； 三组患者各级视功能均无差异(P>0.05)； 2.5 IU BTA注射组和5.0 IU BTA注射组治疗后并发症总发生率无显著差异(43% vs 52%，P>0.05)。

结论：对于斜视度≥+60 PD的AACE患者，双眼内直肌注射5.0 IU BTA可以取得与传统眼外肌手术相当的效果，且其具有创伤小，操作简单方便的优势。

METHODS: A retrospective analysis was conducted on clinical data of 60 patients with AACE treated at our hospital from June 2020 to December 2022. Patients were divided into three groups based on different treatments: 2.5 IU BTA injection group(14 cases), 5.0 IU BTA injection group(29 cases), and surgical group(17 cases). Follow-up was conducted for 6 mo after treatment to observe the degree of strabismus after the correction of refractive error, visual function, treatment effectiveness, and occurrence of complications after BTA injection.

RESULTS: At 6 mo post-treatment, the degree of strabismus in the surgical group and the 5.0 IU BTA injection group was lower than that in the 2.5 IU BTA injection group(P<0.017). However, there was no significant difference in the degree of strabismus between the surgical group and the 5.0 IU BTA injection group(P>0.017). The effective rate of the 5.0 IU BTA injection group was higher than that of the 2.5 IU BTA injection group(86% vs 43%, P<0.017). There was no difference in visual function among the three groups(P>0.05). The incidence of complications after treatment was not significantly different between the 2.5 IU BTA injection group and the 5.0 IU BTA injection group(43% vs 52%, P>0.05).

CONCLUSION: For AACE patients with esotropia degree ≥+60 PD, bilateral medial rectus injection of 5.0 IU BTA can yield outcomes comparable to traditional extraocular muscle surgery, with the advantages of minimal trauma and simple and convenient operation.