A型肉毒毒素治疗儿童间歇性外斜视的近期效果

Short-term result of management of childhood intermittent exotropia with botulinum toxin A

目的观察A型肉毒毒素(BTXA)治疗儿童间歇性外斜视的临床效果。设计回顾性病例系列。研究对象40例4～12岁间歇性外斜视患儿。方法明确告知常规手术治疗(双外直肌后退或外直肌后退联合内直肌折叠术)和BTXA眼外肌注射治疗各自优缺点后,将符合入选标准的间歇性外斜视患儿根据其家长选择的治疗方式分为2组,每组20例,分别采用上述两种治疗方式,治疗3个月后比较两组患儿的眼位及双眼视觉功能。主要指标眼位,双眼视觉功能。结果治疗3个月后,注射组中15例(75%)患儿眼位正位,手术组中18例(90%)患儿眼位正位,两组患儿之间正位率比较差异无统计学意义(P=0.4042)。两组患儿的双眼视觉功能较治疗前均有明显提高。治疗后两组均有患儿重建了融合功能,两组均有患儿获得了远立体视觉,且近立体视觉也得到明显改善。结论BTXA注射作为一种快捷、侵入性小的治疗方式,其早期临床疗效可能至少与手术治疗相当。(眼科,2008,17:126—129)

Objective To observe the effect of botulinum toxin A （BTXA） in treating childhood intermittent exotropia. Design Retrospective case series. Participants 40 children ranging from 4 to 12 years of age diagnosed with intermittent exotropia. Methods To the patients explained the advantages and disadvantages of surgery （bilateral lateral rectus muscle recession or resection of a medial rectus muscle and recession of the lateral rectus muscle） and extraocular muscle injection of BTXA. Proper children were divided into 2 groups according to their parents＇ choices. There were 20 patients in each group who received the two different therapies. To compare the binocular alignment of the eyes and the binocular visions of these children at 3 months after treatment. Main Outcome Measures Binocular alignment of the eyes, binocular vision. Results At 3 postoperative months, there were 15 （75%） patients got orthophoria in BTXA group and 18 （90%） patients got orthophoria in surgery group. There was no significant difference in the binocular alignment between group 1 and group 2 （P=0.4042）. All the patients got better results in binocular visions. There were patients who got fusion re-buih and got distance stereopsis in both groups. Meanwhile, there were patients whose near stereopsis got improved in both groups. Conclusion BTXA injection is a rapid and less invasive procedure may be at least as effective as surgical outcomes for the treatment of intermittent exotropia in children.