A型肉毒毒素注射治疗急性共同性内斜视的临床观察  

Clinical observation of botulinum toxin A injection in the treatment of acute comitant esotropia:a retrospective cohort study

作　　者：王颖[1] 郎丽娟[1] 许丽敏[1] 荣军博[1] 郭可心 张陆希 张炯 李志刚[1] 李莉[2] Wang Ying;Lang Lijuan;Xu Limin;Rong Junbo;Guo Kexin;Zhang Luxi;Zhang Jiong;Li Zhigang;Li Li(Department of Ophthalmology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Department of Ophthalmology,Beijing Children′s Hospital,Capital Medical University,National Center for Children′s Health,Beijing 100045,China)

机构地区：[1]郑州大学第一附属医院眼科,郑州450052 [2]国家儿童医学中心首都医科大学附属北京儿童医院眼科,北京100045

出　　处：《中华眼科杂志》2024年第1期49-55,共7页Chinese Journal of Ophthalmology

基　　金：国家卫生健康委科学研究基金——河南省医学科技攻关计划省部共建项目(SB201901013);河南省高等学校重点科研项目计划(22B320016)。

摘　　要：目的观察不同剂量的A型肉毒毒素(BTA)注射治疗急性共同性内斜视(ACE)的效果和安全性。方法回顾性队列研究。纳入2019年6月至2022年6月于郑州大学第一附属医院就诊并接受BTA注射治疗的ACE患者资料。所有患者行最佳矫正视力(BCVA)、等效球镜度数(SE)等常规眼科检查和斜视专科检查,包括斜视度数、眼球运动状况和双眼视功能。将患者按治疗前斜视度数分为小斜视度数[≤60三棱镜度(PD)]和大斜视度数(>60 PD),两种类型的患者均按注射剂量分为2.5 U组和5.0 U组。单眼注射者均为非主导眼注射。记录并比较各组患者治疗前和治疗后1、2、3、6个月随访时的斜视度数。记录各组治疗有效患者占比。比较治疗后6个月时具有各级视功能(包括同时视、近立体视和远立体视)的例数,观察随访期间内并发症的情况。采用t检验、Mann-Whitney U检验和χ^(2)检验进行统计学分析。结果共纳入患者70例,其中男性46例,女性24例,年龄为5.0(4.0,8.3)岁。小斜视度数患者37例,其中2.5 U组25例,5.0 U组12例;大斜视度数患者33例,其中2.5 U组18例,5.0 U组15例。小斜视度数和大斜视度数ACE患者中2个组的年龄、病程、治疗前斜视度数、BCVA、SE等基线资料差异均无统计学意义(均P>0.05)。小斜视度数患者中,治疗后1和2个月时,5.0 U组的斜视度数分别为-20.00(-37.50,-7.00)和0.00(0.00,0.00)PD,小于2.5 U组的0.00(-10.00,4.50)和5.00(0.00,6.50)PD,差异均有统计学意义(均P<0.05);治疗后3和6个月时2.5 U组的斜视度数分别为5.00(0.00,15.00)和2.00(0.00,6.00)PD,5.0 U组分别为0.00(0.00,4.50)和0.00(0.00,3.75)PD,差异均无统计学意义(均P>0.05)。2.5 U组20例治疗有效,占80.0%,5.0 U组10例有效,占10/12,差异无统计学意义(P>0.05)。2.5 U组和5.0 U组具有各级视功能的例数占比分别为同时视76.0%(19/25)和10/12,近立体视48.0%(12/25)和7/12;远立体视44.0%(11/25)和7/12,差异均无统计学意义(Objective To observe the efficacy and safety of botulinum toxin A(BTA)injection in the treatment of acute comitant esotropia(ACE)with different doses.Methods This retrospective cohort study included data from patients with ACE who received BTA injection treatment at the First Affiliated Hospital of Zhengzhou University from June 2019 to June 2022.All patients underwent routine ophthalmic examinations,including best-corrected visual acuity(BCVA),spherical equivalent(SE),as well as specialized examinations for strabismus,including the degree of esotropia,eye movement status,and binocular visual function.Patients were categorized into small esotropia[≤60 prism diopters(PD)]and large esotropia(>60 PD)groups based on the pre-treatment degree of esotropia.Each group was further divided into 2.5 U and 5.0 U dose subgroups.Monocular injections were administered to the non-dominant eye.The esotropia degree was recorded and compared at 1,2,3,and 6 months of follow-up.The proportion of effectively treated patients in each group was documented.The number of cases with various levels of visual functions(including simultaneous vision,near stereopsis,and distance stereopsis)at 6 months post-treatment was compared,and complications during the follow-up period were observed.Statistical analyses were conducted using t-tests,Mann-Whitney U tests,and χ^(2) tests.Results A total of 70 patients were included in the study,comprising 46 males and 24 females,with a median age of 5.0(4.0,8.3)years.Among them,37 patients had small esotropia,with 25 in the 2.5 U group and 12 in the 5.0 U group.Thirty-three patients had large esotropia,with 18 in the 2.5 U group and 15 in the 5.0 U group.There were no statistically significant differences in baseline data,including age,duration of the condition,pre-treatment esotropia degree,BCVA and SE,between the two dose groups in both small and large esotropia patients(all P>0.05).In small esotropia patients,at 1 and 2 months post-treatment,the esotropia degree in the 5.0 U group was-20.00(-37.50,-7.0

关 键 词：急性病 内斜视 肉毒杆菌毒素类 A型 注射 眼内 治疗结果 

分 类 号：R777.41[医药卫生—眼科]