A型肉毒素显微注射治疗急性共同性内斜视的临床疗效分析

doi:10.6040/j.issn.1673-3770.0.2018.547

摘要/Abstract

摘要： 目的探讨手术显微镜下经球结膜微小切口眼外肌A型肉毒毒素(BTXA)显微注射治疗急性共同性内斜视(AACE)的临床疗效。方法回顾2017年3月至2018年7月于青岛眼科医院行BTXA显微注射治疗的AACE患者资料。注射前行眼科常规检查、眼位、眼球运动及复视检查并记录。于手术显微镜下经内直肌附着处1~2 mm的球结膜微小切口暴露内直肌止端完成BTXA注射。注射后1周、1个月及3个月时行眼科常规检查、眼位、眼球运动及复视检查并记录。结果患者共28例(30眼)。治疗前平均斜视度为(33.2±15.6)^△(+15^△~+60^△)。治疗1周、1个月、3个月时的平均斜视度数分别下降至(9.8±7.2)^△(P<0.001)、(7.8±3.4)^△(P<0.001)、(9.3±5.2)^△(P<0.001);术后1周、1个月、3个月复诊的斜视度之间差异无统计学意义(P>0.05)。术后1周复查时,6.7%(2/30)的注射眼出现眼上睑轻度下垂,6.7%(2/30)的注射眼出现<10^△的垂直斜视,1个月复诊时以上症状均消失;注射后3个月,78.6%(22/28)的患者复视症状消失,7.2%(2/28)的患者复视减轻,14.2%(4/28)的患者未见明显改变。结论 BTXA显微注射治疗AACE操作安全、并发症发生率较低、治疗效果确切,是无肌电图引导下眼外肌注射的较理想选择。

关键词: A型肉毒素, 急性共同性内斜视, 显微手术

Abstract: Objective To investigate the clinical efficacy of microinjection of botulinum toxin type A(BTX-A)into extraocular muscles through a microsurgical microincision of the bulbar conjunctiva in the treatment of acute acquired concomitant esotropia(AACE). Methods A retrospective analysis of continuous cases was performed. The data of AACE patients treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018 were reviewed. Routine examination was conducted, and the eye position, eye movement, and diplopia before injection were recorded. BTX-A injection was administered under a surgical microscope through a small conjunctival incision of 1-2 mm at the adhesion of the internal rectus muscle to expose its distal end. Routine ophthalmic examination was performed, and eye position, eye movement, and diplopia were examined 1 week, 1 month, and 3 months after the injection. Results A total of 28 AACE patients(30 eyes)were treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018. The average strabismus before treatment was 33.2±15.6^△(+15^△~+60^△). The mean strabismus at 1 week, 1 month, and 3 months of treatment decreased to 9.8±7.2^△ (P< 0.001), 7.8±3.4^△(P<0.001), 9.3±5.2^△(P<0.001), respectively. There were no statistically significant differences in strabismus between the patients who were re-examined 1 week, 1 month, and 3 months after the surgery (P>0.05). Postoperative review after 1 week, 6.7%(2/30)of the injection eye eyelid ptosis slightly, 6.7%(2/30)of the injected eye < 10 training vertical strabismus, 3m re-examination of the above symptoms have disappeared. Three months after the injection, the symptoms of diplopia disappeared in 78.6%(22/28)patients, decreased in 7.2%(2/28)patients, and showed no significant change in 14.2%(4/28)patients. Conclusion BTX-A microinjection for AACE is safe, has a low incidence of complications, is effective, and is an ideal choice for the injection of extraocular muscles without EMG guidance.

Key words: Type A botulinum toxin, Acute acquired concomitant esotropia, Microsurgery

中图分类号:

R777.4+1

岳鹏程,王园,万晓梅,宫华青. A型肉毒素显微注射治疗急性共同性内斜视的临床疗效分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 119-122.

YUE Pengcheng, WANG Yuan, WAN Xiaomei, GONG Huaqing. Clinical analysis of botulinum toxin type A microinjection in the treatment of acute acquired concomitant esotropia[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2019, 33(2): 119-122.

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