Objective To compare long-term surgical outcomes of augmented bilateral lateral rectus recession and bilateral lateral rectus recession-unilateral medial rectus resection in large-angle exotropia.Methods Medical records of patients (159 patients) with large-angle exotropia who underwent augmented bilateral lateral rectus recession (more than 8mm) were retrospectively reviewed and compared to those received traditional bilateral lateral rectus recession-unilateral medial rectus resection(63patients) between 2012 and 2015.Patients were observed for at least 2 years.Results At follow-up of 2 years,79 of 96 patients (82.3％) received augmented surgery maintained successful alignment;11 (11.5％)had under correction,6 (6.3％) had over correction,and exotropia recurred in 2(2.1％) patients.Mter traditional surgery,47 of 63 patients (74.6％) were successfully aligned,15(23.8％) had under correction,1 (1.6％) had over correction,and 9(14.2％) had recurrence.Augmented surgery is related with higher long-term success rate (P ＜0.05),lower tmder correction rate(P ＜ 0.05) and lower recurrence rate(P ＜ 0.05).However,augmented surgery also resulted in higher over correction rate (P ＜ 0.05).No patients complained eye movement problem in the 2 groups.Conclusions Augmented bilateral LR recession (＞ 8 mm) resulted in more successful alignment,lower under correction rate and lower recurrence,without eye movement complications.Augmented bilateral LR recession helps long-term stability of the alignment by reducing recurrence and improving success rate.However,it also resulted in higher over correction rate,which should be considered when planning bilateral LR large recession.%目的 比较常规双眼外直肌后退加内直肌缩短手术方式与双外直肌超常量后退手术方式在大角度外斜视治疗中的长期疗效.方法 选本院2012年2月至2015年2月期间采用超常量外直肌后徙手术治疗外斜视患者96例,并与同期行常规手术的大角度外斜视患者63例对比,比较2组患者术后2年的疗效包括成功率、欠矫率、过矫率以及眼球运动受限情况.结果 术后2年,超常量组成功率明显高于传统组(分别为82.3％、74.6％),复发率明显低于传统组(分别为2.1％、14.2％),欠矫率明显低于传统组(分别为11.5％、23.8％),过矫率明显高于传统组(分别为6.3％、1.6％),差异有统计学意义(P＜0.05).2组均无眼球运动受限.超常量组有2例早期眼位正常的患者术后6个月出现内斜.传统组3例过矫患者术后采用非手术治疗后2例恢复正位,仅1例再次手术.超常量组6例过矫患者术后采用保守治疗无效均再次手术.结论 在大角度外斜视患者中,双眼外直肌超常量后退术手术成功率明显提高、复发率明显降低,但其矫正过度的发生率明显升高,且临床发现超常量组过矫患者很难用非手术方法恢复双眼正位.超常量双眼外直肌后退术治疗大外斜视是一种安全有效的手术方式,对于减少外斜视的复发率有具有临床价值,但在手术设计中应尽量避免过矫.
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