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  

Clinical analysis of botulinum toxin type A microinjection in the treatment of acute acquired concomitant esotropia

作　　者：岳鹏程 王园 万晓梅[2] 宫华青[2] YUE Pengcheng;WANG Yuan;WAN Xiaomei;GONG Huaqing(Weifang Medical University, Weifang 261053, Shandong, China;Shandong Institute of Ophthalmology, Qingdao Eye Hospital, Qingdao 266071, Shandong, China)

机构地区：[1]潍坊医学院,山东潍坊261053 [2]山东省眼科研究所青岛眼科医院,山东青岛266071

出　　处：《山东大学耳鼻喉眼学报》2019年第2期119-122,共4页Journal of Otolaryngology and Ophthalmology of Shandong University

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。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±15.6A(+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 reexamined 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 guidanee.

关 键 词：A型肉毒素 急性共同性内斜视 显微手术 

分 类 号：R777.41[医药卫生—眼科]