A型肉毒素注射与眼外肌移位术对不同时期急性共同性内斜视患者的疗效分析

Efficacy of botulinum toxin A injection versus transposition of extraocular muscle on acute acquired concomitant esotropia in different stages

目的 探讨A型肉毒素(BTA)注射与眼外肌移位术治疗不同时期的急性共同性内斜视(AACE)患者的临床疗效。方法 回顾性分析2020年1月至12月就诊于西京医院眼科的AACE患者33例(66眼),发病6个月以内者(9例)予以BTA注射(注射组),发病6个月及以上者(24例)予以眼外肌移位术(手术组)。记录患者一般资料,术前和术后(1周、1个月、3个月、6个月)斜视度,术前和术后6个月远、近立体视,术后6个月治愈率。重复测量数据采用重复测量数据的方差分析,计量资料比较采用非参数检验,计数资料比较采用卡方检验。结果 两组患者间性别比例、年龄、日近用眼时长、双眼平均等效球镜度数比较差异均无统计学意义(均为P>0.05)。注射组患者术前,术后1周、1个月、3个月、6个月斜视度分别为(36.89±13.79)△、(5.00±7.09)△、(1.00±3.73)△、(1.61±2.51)△、(3.00±4.56)△;手术组患者术前,术后1周、1个月、3个月、6个月斜视度分别为(37.94±19.58)△、(0.65±1.34)△、(1.31±1.22)△、(1.98±2.20)△、(2.15±1.43)△,两组患者术后1周、1个月、3个月、6个月斜视度均较术前降低,差异均有统计学意义(均为P<0.001);两组患者手术前后不同时间点斜视度组间和交互作用比较差异均无统计学意义(均为P>0.05)。术后6个月,注射组8例(88.9%)患者存在近立体视,9例(100.0%)患者存在远立体视,手术组23例(95.8%)患者存在近立体视,24例(100.0%)患者存在远立体视,两组患者术后6个月远、近立体视均较术前提高,差异均有统计学意义(均为P<0.05);两组患者间术前及术后6个月远、近立体视比较差异均无统计学意义(均为P>0.05)。术后6个月,注射组8例(88.9%)患者斜视治愈、手术组24例(100.0%)患者斜视治愈,两组患者间术后6个月斜视治愈率比较差异无统计学意义(P>0.05)。结论 BTA注射和眼外肌移位术均能够治疗不同时期的AACE。其中BTA注射对于发病小于6个月的患者同样效果显著,可将其作为AACE发病早期首选治疗方案。

Objective To explore the clinical efficacy of botulinum toxin A(BTA)injection and transposition of extraocular muscle on acute acquired concomitant esotropia(AACE)at different stages.Methods A retrospective analysis was carried out on 33 AACE patients(66 eyes)who visited the Department of Ophthalmology,Xijing Hospital from January to December 2020.BTA was injected in patients whose course of disease was less than 6 months(n=9,injection group),and transposition of extraocular muscle was performed in patients whose course of disease was 6 months or longer(n=24,surgery group).The general data,preoperative and postoperative(1 week,1 month,3 months,and 6 months)strabismus degree(SD),preoperative and 6-month postoperative far and near stereopsis,and 6-month postoperative cure rate were observed.Variance analysis for repeated measurements was performed,measurement data were compared by a non-parametric test,and enumeration data were compared by a Chi-squared test.Results There was no statistically significant difference regarding gender ratio,age,daily eye usage time,and the average spherical equivalent of both eyes(all P>0.05).The SD at baseline,1 week,1 month,3 months and 6 months after the treatment in the injection group were(36.89±13.79),(5.00±7.09),(1.00±3.73),(1.61±2.51)and(3.00±4.56),respectively,whereas those were(37.94±19.58),(0.65±1.34),(1.31±1.22),(1.98±2.20)and(2.15±1.43)for patients in the surgery group,respectively.The SD at 1 week,1 month,3 months and 6 months was lower than that at baseline in both groups,with significant differences(all P<0.001).There was no significant difference in the SD at different time points between the two groups(all P>0.05).At 6 months after the treatment,in the injection group,8 patients(88.9%)had near stereopsis and 9 patients(100.0%)had far stereopsis;in the surgery group,23 patients(95.8%)had near stereopsis and 24 patients(100.0%)had far stereopsis.The far and near stereopsis of patients in the two groups improved 6 months after the treatment compared with those at baseline(all P<0.05).There was no significant difference in the far and near stereopsis between the two groups before and 6 months after the treatment(all P>0.05).At 6 months after the treatment,8 patients(88.9%)in the injection group and 24 patients(100.0%)in the surgery group were cured,with no statistically significant difference in the cure rate(P>0.05).Conclusion Both BTA injection and transposition of extraocular muscle are effective for AACE in different stages.BTA injection has significant efficacy for patients with a course of less than 6 months and can be used as the preferred option in the early stage of AACE.