目的：探讨A型肉毒杆菌毒素(BTXA)注射与斜视手术治疗急性共同性内斜视(AACE)的疗效差异。

方法：回顾性分析2019年1月至2023年9月南通市第一人民医院收治的AACE病例资料。根据治疗方式将患者分为手术组与BTXA注射组，并按术前斜视度\〖>35棱镜度(PD)与≤35 PD\〗和年龄(≥18岁成人组与<18岁青少年组)进行分层，采集患者基线特征，记录治疗前后多个时间点的斜视度，评估立体视觉功能。通过亚组疗效对比系统评估不同治疗方案的临床价值。

结果：共纳入43例AACE患者。末次随访时，手术组与注射组斜视度均较治疗前显著降低(P<0.001)。两组在斜视治愈率与立体视觉恢复率方面存在显著差异(P<0.05)。对于斜视度>35 PD患者，手术后斜视度控制、成功率及立体视觉恢复方面均优于注射治疗(P<0.05)； 在≥18岁患者中，手术在斜视矫正、成功率提升和立体视觉重建方面同样更具优势(P<0.05)。

结论：BTXA注射与斜视手术对AACE均具有治疗价值。手术治疗总体疗效优于BTXA注射，尤其适用于斜视度>35 PD及年龄≥18岁的患者； 对于斜视度≤35 PD或未成年患者，BTXA注射仍可作为可行的治疗选择。

METHODS:Patient records of AACE cases treated at First People's Hospital of Nantong from January 2019 to September 2023 were retrospectively analyzed in this study. Patients were categorized into either strabismus surgery or BTXA injection groups based on treatment modality. Further stratification was performed according to preoperative deviation angles \〖>35 prism diopters(PD)vs ≤35 PD\〗 and age(≥18 years adult group vs <18 years adolescent group). The baseline patient characteristics were collected, deviation angles at multiple timepoints before and after treatment were measured, and stereopsis test results were documented. Through comparative analysis of therapeutic outcomes across subgroups, we systematically evaluated the efficacy of different treatment approaches.

RESULTS:A total of 43 AACE patients were included. At the final follow-up, both the surgery and BTXA injection groups showed a statistically significant decrease in deviation angle compared to pretreatment measurements(P<0.001). Significant differences were noted between the two groups in terms of the cure rate of strabismus and the recovery rate of stereopsis(P<0.05). For patients with deviations >35 PD, surgery yielded significantly better outcomes than injection therapy in postoperative angle, success rate, and stereopsis recovery(P<0.05). Similarly, in patients aged ≥18 years, surgical treatment was superior to injections in reducing strabismus angle, improving success rates, and restoring stereopsis(P<0.05).

CONCLUSION:Both BTXA injection and strabismus surgery demonstrate therapeutic efficacy in AACE. Surgical treatment demonstrated superior efficacy compared to BTXA injection therapy, particularly in patients with deviations >35 PD and those aged ≥18 years. For patients with angles ≤35 PD or under 18 years, BTXA injection remains a viable treatment option.