A型肉毒杆菌毒素治疗急性共同性内斜视疗效研究

Observation on effect of botulinum toxin type A for treating acute comitant esotropia

目的评价A型肉毒杆菌毒素(BoNT-A)治疗早期急性共同性内斜视(ACE)的疗效。方法回顾2017年1月至2018年1月在该院治疗的8例早期ACE成人患者,发病时间不超过半年,平均年龄(22.9±5.83)岁。所有患者在明确诊断后,在手术室表面麻醉下接受BoNT-A注射治疗。根据患者术前检查斜视度的差异将不同剂量的BoNT-A注射入其斜视眼的内直肌肌腹内。于治疗后1d、1周、1个月、3个月、6个月、12个月对患者复视和斜视改善情况定期门诊随访,随访三棱镜斜视度、同视机和Hess屏等检查结果。结果患者治疗后1d至2个月复视消失、眼位恢复正位(<±10PD),平均起效时间7~14d,效果维持最长1年以上,治愈率100%。其中3例病例在早期出现轻中度上睑下垂,1例病例出现过矫和小于10PD的垂直斜视及球结膜下少量出血等并发症,均在2个月内消退。1例病例在治愈1年后复发,接受再次治疗很快治愈。结论用BoNT-A注射治疗早期ACE效果良好。

Objective To evaluate the efficacy of botulinum toxin type A（BoNT-A）in the treatment of early acute comitant esotropia（ACE）.Methods Eight patients with early ACE treated in this hospital from January 2017 to January 2018 were reviewed.The onset time did not exceed half a year with a mean age of22.9（22.9±5.83）years old.All cases received the BoNT-A injection treatment under topical anesthesia in the operating room after definite diagnosis.According to the differences of strabismus degree detected before operation,the different doses of BoNT-A were injected into the medial rectus muscles of oblique eyes.Then the patients were regularly followed up for observing the improvement of diplopia and strabismus at 1 week,1 month,3 months,6 months and 12 months after treatment.The results of triple prism strabismus degree,synoptophore and Hess screen examinations were followed up.Results Diplopia in all cases disappeared in 1 day to 2 months after treatment,the ocular position recovered to orthotropia（〈±10 PD）,the average onset time was 7-14 days and the effect maintenance lasted for more than 1 year,the cure rate was 100%.Among them,3 cases appeared mild to moderate ptosis;and 1 case had overcorrected and showed vertical strabismus（〈10 PD）as well as subconjunctival hemorrhage,the complications disappeared within 2 months;One case recurred after 1 year of cure and was cured quickly by re-treatment.Conclusion BoNT-A injection in the treatment of early ACE has good effect without needing strabismus surgery.