共同性外斜视临床特征和手术效果二十年变化研究OACSTPCD

Objective To analyze the clinical manifestations and surgical treatment outcomes of two groups of con-comitant exotropia(CX)separated by twenty years,and to explore the changing trend of clinical characteristics of CX.Methods Retrospective cohort study.We established two retrospective cohorts of CX patients who underwent surgical treatment at Peking University First Hospital from January 1996 to December 1998 and from January 2016 to December 2018.Collect general information and clinical data at admission and after discharge,perform survival analysis using Kaplan Meier method,and perform multivariate analysis using Cox proportional hazards model to evaluate and compare the clinical characteristics and long-term postoperative outcomes of two groups.Results The positive rates at 1,3,and 5 years after surgery in the 1996 group were 91.94％,70.78％,and 60.71％,respectively;In the 2016 group,the survival rates were 95.05％,66.53％,and 56.65％,respectively,P＞0.05.The survival time of the 1996 group was 38.70±1.84months,while that of the 2016 group was 32.37±5.51months,X2=4.065,P=0.042.Compared with the 1996 group,the 2016 group showed a decrease in the age of onset,age of consultation,and age of surgery,an increase in the proportion of myopia,a decrease in amblyopia,a decrease in the deviation angle,an increase in convergence insufficiency CX and a decrease of deviation angle at 1 week after surgery(P＜0.05).Multivariate Cox proportional hazards regression showed that age of onset(HR=-1.323,P＜0.001),age of surgery(HR=1.085,P=0.027),myopia(HR=2.044,P=0.021),strabismus type(HR=1.015,P=0.022),and 1 week of deviation angle after surgery(HR=1.556,P=0.004)were risk factors affecting the long-term orthotopic rates of CX after surgery.Conclusions Com-pared with the 1996 group,the 2016 group showed new characteristics,including a younger age of onset,an increase in the proportion of myopia,and a significant increase in the group with convergence insufficiency.The 5-year median survival time of the 2016 group was lower than that of the 1996 group.Age of onset,age of surgery,with myopia,type of CX,and postoperative 1-week deviation angle are risk factors affecting the long-term orthotopic rate of CX surgery.