目的：探究外斜漂移量对儿童间歇性外斜视术后远期眼位回退的预测作用。

方法：前瞻性队列设计。选取2023年9月至2025年7月于本院接受手术治疗的间歇性外斜视儿童进行研究，根据术后6 mo时的眼位回退情况分为回退组和未回退组。比较两组的临床资料，分析外斜漂移量与视功能的关系。多元线性回归分析外斜漂移量与视功能的相关性。Logistic多因素分析影响术后远期眼位回退的因素。断点回归设计(RDD)对结果的有效性和稳健性进行评价。分析外斜漂移量与术后远期眼位回退的区间似然比。受试者工作特征(ROC)曲线分析外斜漂移量对术后远期眼位回退的预测价值。限制性立方样条(RCS)分析外斜漂移量与术后远期眼位回退发生风险的剂量-反应关系。

结果：本研究初始纳入间歇性外斜视儿童133例，其中5例失访，最终128例完成随访(回退组43例，未回退组85例)。间歇性外斜视儿童年龄9.89±2.61岁，男82例，女46例。回退组年龄9.82±2.64岁，男26例，女17例。未回退组年龄9.96±2.58岁，男56例，女29例。两组Titmus近立体视、斜视类型、术后1 d眼位、术后1 d外斜漂移量具有明显差异(均P<0.05)。多元线性回归分析结果显示，术后1 d外斜漂移量与视功能无明显相关性(均P>0.05)，术后1 d外斜漂移量不受视功能指标的影响。有Titmus近立体视、斜视类型为集合不足型、术后1 d眼位为内隐型、术后1 d外斜漂移量升高为眼位回退的危险因素(均P<0.05)。当术后1 d外斜漂移量=9 PD时，术后远期眼位回退的发生风险明显下降。当术后1 d外斜漂移量水平≥14 PD时，术后远期眼位回退的概率相对最高。当cut-off值为9 PD时，术后1 d外斜漂移量预测术后远期眼位回退的AUC为0.809(95%CI：0.749-0.869)，预测效能具有较高价值。随着术后1 d外斜漂移量升高，术后远期眼位回退风险随之升高。

结论：术后1 d外斜漂移量是儿童间歇性外斜视术后远期眼位回退的危险因素，二者呈剂量-反应关系。术后1 d外斜漂移量≥14 PD时回退风险最高，以9 PD为最佳截断值对远期眼位回退具有较高预测价值。临床可通过监测术后1 d外斜漂移量评估术后6 mo回退风险，为临床制定个体化随访方案提供参考依据。

METHODS:Prospective cohort study.Children with intermittent exotropia who underwent surgical treatment at the hospital between September 2023 and July 2025 were included. Based on the eye position regression status at 6 mo postoperatively, patients were divided into a regression group and a non-regression group. Clinical data of two groups were compared. The relationship between exodrift and visual function was analyzed. Multivariate linear regression was used to examine the association between exodrift and visual function. Logistic multivariable analysis identified factors influencing long-term postoperative eye position regression. A regression discontinuity design(RDD)was employed to evaluate the validity and robustness of the results. Interval likelihood ratios were analyzed to assess the relationship between exodrift and long-term postoperative eye position regression. Receiver operating characteristic(ROC)curves were used to evaluate the predictive value of exodrift for long-term postoperative eye position regression. Restricted cubic splines(RCS)were applied to analyze the dose-response relationship between exodrift and the risk of long-term postoperative eye position regression.

RESULTS:This study initially included 133 children with intermittent exotropia. Among them, 5 cases were lost to follow-up. Eventually, 128 cases completed the follow-up(43 cases in the regression group and 85 cases in the non-regression group). The age of the children with intermittent exotropia ranged from 2 to 15 y(mean 9.89±2.61 y), with 82 boys and 46 girls. The age of the regression group was 9.82±2.64 y(26 boys and 17 girls). The age of the non-regression group was 9.96±2.58 y(56 boys and 29 girls). The two groups showed significant differences in Titmus near stereopsis, strabismus type, postoperative day 1 eye position, and postoperative day 1 exodrift(all P<0.05). There was no significant correlation between the amount of exodrift 1 d after the surgery and visual function(all P>0.05). Multiple linear regression analysis showed that there was no statistical significance between visual function and the amount of exodrift 1 d after surgery(all P>0.05). Titmus near stereopsis, convergence insufficiency type of strabismus, inward deviation(esophoria)at 1 d postoperatively, and an increased exodrift at 1 d postoperatively were identified as risk factors for postoperative eye position regression(all P<0.05). When exodrift after surgery was 9 PD at 1 d postoperatively, the risk of long-term eye position regression after surgery significantly decreased(P<0.001). When exodrift of the eye after surgery ≥14 PD at 1 d postoperatively, the probability of long-term eye position regression was relatively highest. When the cut-off value was 9 PD, the AUC of the predicted postoperative 1-day exodrift for predicting the long-term postoperative eye position regression was 0.809(95%CI: 0.749-0.869), indicating a relatively high predictive value. As the amount of exodrift increases 1 d after the surgery, the risk of long-term eye position regression also increases.

CONCLUSION:The amount of exodrift 1 d after surgery is arisk factor for the long-term eye position regression in children with intermittent exotropia. The two are in a dose-response relationship. When the amount of exodrift 1 d after surgery is ≥14 PD, the risk of regression is the highest. The optimal cut-off value of 9 PD has a high predictive value for long-term eye position regression. Clinically, the amount of exodrift 1 d after surgery can be monitored to assess the risk of regression 6 mo after surgery, providing a reference basis for the clinical formulation of individualized follow-up plans.