急性共同性内斜视的早期治疗效果探讨  

Management of acute comitant esotropia at early stage

作　　者：陈平[1] 万鲁芹[1] 李春建[1] 宫华青[1] 

机构地区：[1]山东省医学科学院,山东省眼科研究所,青岛266071

出　　处：《中国实用眼科杂志》2012年第7期849-852,共4页Chinese Journal of Practical Ophthalmology

摘　　要：目的探讨急性共同性内斜视早期进行安全有效处理的方法。方法选取2010年4月至2011年3月在眼肌科门诊就诊的急性共同性内斜视患者6例。平均年龄24．5岁，平均病程10周。治疗前三棱镜＋马氏杆检查内斜视度数平均为＋25△（33em），远、近距离内斜视角度基本相等。同视机检查融合范围较正常小，平均为-3．3°-＋9．2°。排除中枢神经系统、内分泌系统异常及其它疾病后，在外科手术显微镜下使用我们自创的眼表微创注射法将肉毒毒素注入眼外肌肌腹。结果6例患者随访时间6-18个月。一次注射后5例眼位正，自觉复视症状消失，融合范围不同程度增加，且病情稳定未见复视再次发生。另1例在注射后3个月复视再次出现，再次行该药物注射。此患者在发病后11个月因内斜视和复视的反复发作而行内斜矫正手术。药物注射后6例患者均未发生外斜视和上睑下垂等并发症。结论急性共同性内斜视发病早期行眼外肌肉毒杆菌类毒素注射治疗，可以达到有效地消除和缓解复视和斜视的作用，对大多数患者可以达到治愈目的。Objective To investigate the effect of injection of botulinum toxin A （BTXA） on acute comitant esotropia （ACE） at early stage. Methods The injection of BTXA in 6 patients with ACE from April 2010 to March 2011 in Shandong Eye Institute were retrospectively analyzed. The mean age at presentation was 24.5 years, and the average time from onset of acute esotropia to in- jection was 10 weeks. The mean angel of esotropia was equal for distance and for near fixation （dif- fering by 〈5 prism diopters）, measurd by the prism and cover tests, which was ＋25△. The range of fusion was lower than normal, which was -3.3°-＋9.2°. A minimal conjunctival incision was made under a microscope, followed by the injection of BTXA in the medial rectus of the squinting eye. Results After the injection, all patients did not develop ptosis and exotropia during the follow-up of 6 to 18 months. Five patients obtained eye orthotroplia, disappearance of diplopia and increasing fu- sion. One patient who suffered from diplopia received the injection again 3 months after first injec- tion. This patient underwent a surgical treatment at 11 months after onset because of esotropia and diplopia which repeatedly occurred. Conclusions Injection of BTXA is satisfactory and effective management of ACE at early stage.

关 键 词：急性共同性内斜视 肉毒杆菌类毒素 显微外科手术 

分 类 号：R777.41[医药卫生—眼科]