方法：前瞻性临床研究。对2009-01/2010-12在南昌大学第二附属医院儿童眼科接受水平斜视矫正术的3～8岁儿童进行随访，搜集资料完整、无失访的患儿178例318眼。分为四组，分别为外直肌后徙术(Ⅰ组)，内直肌后徙术(Ⅱ组)，内直肌后徙+外直肌缩短组(Ⅲ组)，外直肌后徙+内直肌缩短组(Ⅳ组)。排除全身重大疾病及眼部器质性病变。进行术前1mo，术后1wk，1，2，4，8mo的眼部检查、弱视相关检查、散瞳检影检查。

结果：术后1wk， Ⅲ和Ⅳ组患儿散瞳检影球镜屈光度与术前比较有明显差异(P<0.05)，术后1mo各组与术前比较已无明显差异(P>0.05)，术后8mo各组的球镜屈光度较术前出现一定程度下降(P<0.05)。术后1wk各组柱镜屈光度与术前比较存在明显差异(P<0.05)。术后1mo，Ⅲ和Ⅳ组柱镜屈光度与术前比较仍有明显差异(P<0.05)。术后2mo后各组与术前比较均无明显差异(P>0.05)。术后各时段与术前比较，散光的循规性及散光轴基本保持不变。

结论：儿童水平斜视手术后短期内的屈光度确实存在变化，但在一定时间内多可恢复至术前水平。总的来说，不同术式对术后屈光度变化的影响并无明显差异。一般情况下，患儿散瞳验光配镜可于术后2mo以后进行，最迟不应超过4mo。

METHODS: In a prospective interventional case series, 318 eyes of 178 patients aged of 3-8 years in the Second Affiliated Hospital of Nanchang University from January, 2009 to December, 2010 were evaluated in 4 groups:(Ⅰ)48 patients(83 eyes)who underwent external rectus muscle(s)recession;(Ⅱ)43 patients(79 eyes)who underwent internal rectus muscle(s)recession;(Ⅲ)45 patients(81 eyes)who underwent internal rectus muscle(s)recession combined external rectus muscle(s)resection;(Ⅳ)42 patients(75 eyes)who underwent external rectus muscle(s)recession combined internal rectus muscle(s)resection. Full ophthalmic examination and mydriatic optometry was carried out 1 month before surgery, as well 1 week and 1 month, 2, 4, 8 months after surgery.

RESULTS: In groupⅢ and Ⅳ, compared with pre-operation, there were statistically significant changes in spherical equivalent at 1 week(P<0.05), and no significant changes happened in all 4 groups at 1 month. Significant decrease was found in all groups at month 8(P<0.05). In all groups, there were statistically significant changes in cylinder equivalent at 1 week(P<0.05). At month 1 post-operation, same result was detected in group Ⅲ and Ⅳ. No significant changes in cylinder equivalent happened in all 4 groups at month 2(P>0.05). Astigmatic axis shift was little in all groups at any time point(P>0.05), and rule of eyes astigmatism were kept coincidence with pre-operation very well(P>0.05).

CONCLUSION: Refractive changes are assured in short-term after horizontalrectus muscle surgery, while generally speaking, refractive statues can recover to the level of pre-operation in a certain duration. No significant variation is found between different surgery methods. It does not seem necessary to perform cycloplegic refraction early than 2 months after surgery; however, considered about emmetropia proceeding in children, a precise refraction in all cases of strabismus should not be deferred later than 4 months.