A型肉毒素治疗不同病程急性共同性内斜视疗效分析

The Efficacy of Botulinum Toxin Type A Injection for Acute Acquired Comitant Esotropia with Different Courses

目的:比较A型肉毒素注射对不同病程急性共同性内斜视的治疗效果。方法:回顾性系列病例研究。连续性纳入2019年10月至2023年6月就诊于西京医院采用A型肉毒素治疗的急性共同性内斜视患者56例,根据病程分组:病程<6个月组(30例)、病程≥6个月组(26例)。观察患者一般资料,治疗前、治疗后(1周、1个月、3个月、6个月)斜视度,治疗前、治疗后6个月视功能,重复治疗率,治愈率等。计量资料比较采用t检验、Wilcoxon符号秩检验及Mann-Whitney U检验,计数资料比较采用卡方检验,重复测量数据采用重复测量方差分析。结果:病程<6个月组和病程≥6个月组病程分别为0.5~5(2.7±1.3)个月和6~13(7.9±2.6)个月,2组患者一般资料比较差异均无统计学意义(均P>0.05)。病程<6个月组和病程≥6个月组患者治疗前、治疗后(1周、1个月、3个月、6个月)斜视度分别为(57.8±21.8)^(△)、(2.9±6.7)^(△)、(3.1±6.2)^(△)、(5.4±10.4)^(△)、(8.3±17.3)^(△)和(51.5±22.5)^(△)、(3.3±5.0)^(△)、(3.5±3.6)^(△)、(6.8±7.0)^(△)、(9.1±9.4)^(△),2组患者治疗后各时间点斜视度均较治疗前降低(均P<0.001);2组间各时间斜视度差异均无统计学意义(均P>0.05)。治疗后6个月,病程<6个月组22例(73%)存在近立体视(Z=3.31,P=0.001)、24例(80%)存在远立体视(Z=4.03,P<0.001);病程≥6个月组16例(62%)存在近立体视(Z=2.72,P=0.006)、22例(85%)存在远立体视(Z=3.21,P=0.001),均较治疗前改善且2组间差异无统计学意义(P>0.05)。2组患者重复治疗率及治愈率比较差异均无统计学意义(均P>0.05)。所有患者中单次注射治愈者较重复治疗者初诊斜视度相对较小(P<0.05)。结论:A型肉毒素注射对不同病程(≤13个月)的急性共同性内斜视患者均有较好疗效,斜视度小者效果可能更佳。

Objective:To compare the efficacy of botulinum toxin type A injection in the treatment of acute acquired comitant esotropia(AACE)with different disease duration.Methods:In this retrospective series case study,totally 56 patients with AACE treated with botulinum toxin type A were retrospectively analyzed and the participants with divided into two groups according to the disease course:disease course<6 months(30 patients)and disease course≥6 months(26 patients).The esodeviation of pretreatment and post-treatment(1 week,1 month,3 months,and 6 months),the stereoacuity before and 6 months after treatment,retreatment and cure rate were analyzed in both groups.Repeated measurement data were analyzed by repeated measurement ANOVA,the measurement data were compared by t-test,wilcoxon signed rank test and Mann-Whitney U test.Counting data were compared by Chi-square test.Results:The duration of the disease in patients of both groups were 0.5-5(2.7±1.3)months and 6-13(7.9±2.6)months.The pretreatment and post-treatment(1 week,1 month,3 months and 6 months)esodeviation were(57.8±21.8)^(∆),(2.9±6.7)^(∆),(3.1±6.2)^(∆),(5.4±10.4)^(∆),(8.3±17.3)^(∆)in disease course<6 months group,and(51.5±22.5)^(∆),(3.3±5.0)^(∆),(3.5±3.6)^(∆),(6.8±7.0)^(∆),(9.1±9.4)^(∆)in disease course≥6 months group,respectively.The esodeviation of the two groups at each follow-up timepoint after treatment was reduced compared with pretreatment(all P<0.001);there was no significant difference of the esodeviation at each follow-up timepoint between the two groups(all P>0.05).There were 22 patients(73%)and 16 patients(62%)had near stereopsis in group disease course<6 months and disease course≥6 months,while,24 patients(80%)and 22 patients(85%)have distance stereopsis,with significantly improvements compared to pretreatment in those two groups(Z=3.31,P=0.001;Z=2.72,P=0.006;Z=4.03,P<0.001;Z=3.21,P=0.001),but there were no significant difference between two groups at 6-month timepoint after treatment(P>0.05).The retreatment and cure rates had no statistical difference between two groups(P>0.05).The esodeviation at first visit in those who received one session of treatment were lower in all patients than that in who received retreatment(P<0.05).Conclusions:Botulinum toxin type A injection were effective in AACE with different disease courses(≤13 months).Patients with low esodeviation might have a better outcomes.