肉毒杆菌A注射和手术治疗急性共同性内斜视的效果比较及影响因素分析  

Comparative study on the effect between botulinum A injection esotropia and surgery in the treatment of esotropia and analysis of influencing factors

作　　者：戚俊凯 贾亚飞 张贝贝 王慧 王传闯 Qi Junkai;Jia Yafei;Zhang Beibei;Wang Hui;Wang Chuanchuang(Department of Strabismus and Pediatric Ophthalmology,Zhoukou Eye Hospital,Zhoukou Seventh People’s Hospital,Zhoukou 466000,China)

机构地区：[1]周口市眼科医院斜视及小儿眼科、周口市第七人民医院,周口466000

出　　处：《中华眼外伤职业眼病杂志》2023年第10期787-794,共8页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的比较肉毒杆菌A注射治疗和手术治疗急性共同性内斜视的效果,并分析疗效的影响因素。方法前瞻性队列研究。选取2019年1月至2021年12月在周口市眼科医院诊治的急性共同性内斜视患者160例,按照随机数字表法分为对照组81例和研究组79例。对照组给予外直肌缩短或内直肌后徙或内直肌后徙+外直肌缩短的手术方式治疗,研究组给予肉毒杆菌A注射治疗。比较两组治疗前、治疗后1个月、1年的斜视度、屈光度、散光轴向,治疗后1个月、1年的视觉三级功能,临床有效率,并发症发生情况以及疗效的影响因素。结果治疗后1个月、1年两组斜视度均较治疗前降低(均P<0.05),治疗1个月两组屈光度均较治疗前升高(P<0.05);治疗后1个月、1年两组散光轴向的改变(P<0.05),但研究组斜视度、屈光度、散光轴向和视觉三级功能与对照组比较,差异均无统计学意义(均P>0.05)。研究组临床治疗总有效率为79.78%(63/79),与对照组的79.01%(64/81)比较,差异无统计学意义(P>0.05)。研究组并发症发生率为2.53%(2/79),明显低于对照组的14.81%(12/81)(P<0.05)。经单因素分析,年龄、病程、治疗前斜视角、治疗前屈光度、治疗前散光轴向是临床治疗疗效的影响因素(P<0.05);经二元Logistic回归分析,年龄是影响急性共同性内斜视患者临床疗效的相关因素(P<0.05)。结论肉毒杆菌A注射治疗与手术治疗急性共同性内斜视疗效相当,均可有效改善斜视角,促进视觉功能恢复,但肉毒杆菌A注射治疗安全性更高;年龄是影响急性共同性内斜视患者临床疗效的相关因素。Objective To compare the efficacy of botulinum A injection and surgery in the treatment of esotropia,and analyze the influencing factors.Methods A prospective cohort study was carried out by selecting 160 cases of acute concomitant esotropia diagnosed and treated in Zhoukou Eye Hospital from Jan.2019 to Dec.2021,and they were divided into a control group(81 cases)and a study group(79 cases)based on random number table method.The control group was treated with external rectus shortening or internal rectus retraction or internal rectus retraction+external rectus shortening,while the study group was treated with Botox A injection.The strabismus,diopter and astigatism axis between the two groups were compared before treatment,at 1 month and 1 year after treatment,and visual tertiary function,clinical effective rate,complications and influencing factors of curative effect were compared between the two groups.Results At 1 month and one year after treatment,strabismus in both groups decreased(all P<0.05),and diopter in both groups increased(P<0.05).At 1 month and one year after treatment,astigmatism axis of the two groups changed(P<0.05),but there was no significant difference in strabismus,diopter,astigmatism axis or visual function between the study group and the control group(all P>0.05).The total effective rate of clinical treatment in the study group was 79.78%(63/79),compared with the 79.01%(64/81)in the control group,the difference was not statistically significant(P>0.05).The incidence of complications in the study group was 2.53%(2/79),which was significantly lower than the 14.81%(12/81)in the control group(P<0.05).By univariate analysis,age,course of disease,oblique visual angle before treatment,diopter before treatment and axial astigmatism before treatment were the influencing factors of clinical therapeutic effect(P<0.05).According to the analysis of binary Logistic regression,age was the related factor affecting the clinical efficacy of patients with acute concomitant esotropia(P<0.05).Conclusion Botulinum

关 键 词：肉毒杆菌A 直肌后徒缩短术 急性共同性内斜视 视觉三级功能 并发症 

分 类 号：R777.41[医药卫生—眼科]