A型肉毒素治疗甲状腺相关眼病上睑退缩  

Botulinum toxin type A treatment for thyroid-related eye disease

作　　者：黎冬平[1] 杜芳[1] 李俊萍 周娜 王育红[1] Li Dongping;Du Fang;Li Junping;Zhou Na;Wang Yuhong(Hankou Aier Eye Hospital,Wuhan,Hubei 430024,China)

机构地区：[1]武汉爱尔眼科医院汉口医院,430024

出　　处：《临床眼科杂志》2018年第6期542-544,共3页Journal of Clinical Ophthalmology

基　　金：武汉市卫生和计划生育委员会科研基金(WX18D13);爱尔眼科医院集团科研基金(AFQ1710D1)

摘　　要：目的观察局部注射A型肉毒素治疗甲状腺相关眼病伴轻度单眼上睑退缩患者的临床效果。方法收集2015年6月至2016年6月期间在我院门诊就诊的19例甲状腺相关眼病并伴单眼轻度上睑退缩(1. 5±0. 26 mm)患者,对患者采用临床活动评分(CAS)标准进行评分,≤3分入选。对入选患者退缩眼行上睑局部低定量(3 u)肉毒素注射2点,分别于注射后1周、1个月、6个月观察双眼的大小变化。结果入选患者注射后1周复诊时均主诉有患眼眼睑沉重感,注射后1个月复诊时眼睑沉重感消失。注射后1周均见患眼上睑退缩好转,平均下移(1. 8±0. 56) mm,注射后1个月下移(1. 6±0. 37) mm;所有患者对侧眼注射后1周均有不同程度上移,平均上移(1. 5±0. 51) mm,注射后1个月时对侧眼眼位稍有回退约(1. 4±0. 46) mm。双眼注射后1个月时已趋于对称,均未见明显并发症。注射后6个月11例患者因上睑再次出现退缩行重复注射。结论局部注射A型肉毒素对甲状腺相关眼病轻度上睑退缩症状疗效确切,维持3～6个月后需要重复注射,为部分患者提供了激素以外的另一选择。Objective To observe the clinical effect of local injection of botulinum toxin type A in the treatment of thyroid-associated ophthalmopathy with mild monocular supracondylar retraction. Methods Nineteen patients with thyroid associated ophthalmopathy accompanied by monocular mild upper eyelid retraction (1.5±0.26 mm) were enrolled in our hospital from June 2015 to June 2016. The patients were scored by CAS activity scoring criteria, less than 3 points selected. The selected patients were resected with a local low-quantity (3 u) botulinum toxin injection at 2 points, and the changes in the size of both eyes were observed at 1 week, 1 month, and 6 months after the injection. Results The patients complained of heaviness of eyelid 1 week after operation. The heaviness of the eyelids disappeared 1 month after injection. The upper eyelid retraction was improved 1 week after injection, with an average decrease of 1.8 ± 0.56 mm,and a decrease of 1.6 ± 0.37 mm 1 month after injection. All patients had different degrees of movement of the lateral eye 1 weeks after injection, with an average shift of 1.5 ± 0.51mm, and a slight regression of the contralateral eye position at about 1.4± 0.46 mm 1 month after injection; Both eyes became symmetrical 1 month after injection, and there were no obvious complications. Eleven patients received repeated injections 6 month after injection when retraction of the upper eyelid recurred. Conclusions Local injection of botulinum toxin type A has definite curative effect on mild upper eyelid retraction of thyroid associated ophthalmopathy, and needs repeated injection after 3~6 months, providing an alternative to hormones for some patients.

关 键 词：GRAVES眼病 上睑退缩 肉毒毒素 

分 类 号：R581[医药卫生—内分泌] R77[医药卫生—内科学]