非肌电图引导Tenon氏囊下注射不同剂量A型肉毒毒素治疗先天性内斜视临床疗效观察

Curative effect of different doses of botulinum toxin A injected under Tenon’s capsule under guidance of non-electromyography in treatment of congenital esotropia

目的:探讨非肌电图引导下Tenon氏囊下注射不同剂量A型肉毒毒素(BTX-A)治疗先天性内斜视的临床疗效。方法:收集37例麻痹性斜视患儿的临床资料,患儿均予以非肌电图引导下Tenon氏囊下注射BTX-A,根据BTX-A使用剂量分为A组(1.25~2.5 U)、B组(2.5~3.75 U),比较两组治疗疗效,并随访6个月,检查其双眼视功能,统计不良反应及再注射率。结果:A组一次性治愈率61.11%,显著低于B组85.29%(P<0.05);治疗后两组双眼视功能分级及左右眼等效球镜比较无统计学差异(均P>0.05),但B组看远斜视度(3.61°±1.43°)显著低于A组[(6.34°±1.75°),P<0.05];A组不良反应发生率20.00%,与B组10.00%比较无统计学差异(P>0.05),但A组再注射率41.67%,显著高于B组17.65%(P<0.05)。结论:非肌电图引导下Tenon氏囊下注射BTX-A可有效改善先天性内斜视患儿斜视症状,且剂量≥2.5 U时的治疗疗效更佳。

Objective:To investigate the clinical curative effect of different doses of botulinum toxin A(BTX-A)injected under Tenon’s capsule under the guidance of non-electromyography(EMG)in the treatment of congenital esotropia.Methods:The clinical data of 37 children with paralytic esotropia were collected.All children were injected with BTX-A under Tenon’s capsule without EMG guidance.According to the dosage of BTX-A,they were divided into group A(1.25 to 2.5 U)and group B(2.5 to 3.75 U).The therapeutic effects of the two groups were compared.They were followed up for 6 months to check their binocular visual function,and the adverse reactions and reinjection rate were counted.Results:The one-time cure rate of group A was significantly lower than that of group B(61.11%vs.85.29%,P<0.05).There was no statistically significant difference in the grade of binocular visual function and binocular spherical equivalent between the two groups after treatment(all P>0.05),but the looking far esotropia degree of group B was significantly lower than that of group A[(3.61°±1.43°)vs.(6.34°±1.75°),P<0.05].There was no statistically significant difference in the incidence of adverse reactions between group A and group B(20.00%vs.10.00%,P>0.05),but the reinjection rate of group A was significantly higher than that of group B(41.67%vs.17.65%,P<0.05).Conclusion:Non-EMG guided Tenon’s subcapsular injection of BTX-A can effectively relieve symptoms of congenital esotropia in children,and the curative effect is better when dose of BTX-A is not less than 2.5 U.