A型肉毒毒素治疗展神经麻痹性斜视的临床观察  

Clinical observation of botulinum toxin type A in the treatment of strabismus caused by abducens nerve palsy

作　　者：薛文琛 范可顺 Xue Wenchen;Fan Keshun(Department of Ophthalmology,Xuzhou First People’s Hospital,the Affiliated Xuzhou Municipal Hospital of Xuzhou Medical University,Institute of Eye Disease Prevention and Treatment of Xuzhou,Xuzhou 221116,China)

机构地区：[1]徐州市第一人民医院眼科,徐州医科大学附属徐州市立医院,徐州市眼病防治研究所,徐州221116

出　　处：《中华眼外伤职业眼病杂志》2024年第7期495-501,共7页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的评估A型肉毒毒素注射治疗早期展神经麻痹性斜视的临床效果。方法回顾性病例系列研究。收集分析徐州市第一人民医院眼科2019年1月至2022年12月的78例(78只眼)展神经麻痹性斜视患者的临床资料。根据斜视度给予内直肌A型肉毒毒素注射2.5~5.0 U,观察注射后斜视度、眼位、眼球运动、复视及并发症情况。注射后随访6个月。结果注射前斜视度27.5Δ(20.0Δ,40.0Δ),注射后1、3、6个月斜视度均为10Δ(5Δ,10Δ),均显著低于注射前(均P<0.001)。注射后1、3、6个月正位率分别为82.05%(64/78),79.49%(62/78),76.92%(60/78),均显著高于注射前(均P<0.001)。注射后1、3、6个月运动受限分级,1级分别为38.46%(30/78)、37.18%(29/78)、35.90%(28/78),均显著高于注射前6.41%(5/78);2级分别为42.31%(33/78),41.03%(32/78),41.03%(32/78),均显著高于注射前20.51%(16/78),注射后运动受限分级均显著低于注射前(均P<0.001),注射后1级、2级比例均增加。注射后1、3、6个月复视分级,消失率分别为50.00%(39/78)、44.87%(35/78)、35.89%(28/78),均显著高于注射前;改善率分别为44.87%(35/78),44.87%(35/78),53.85%(42/78),均显著高于注射前(均P<0.001)。注射后出现一过性轻度上睑下垂6例,2例中度上睑下垂,2例重度上睑下垂,1例<10Δ的垂直斜视,注射后3个月上述症状均消失。结论A型肉毒毒素注射治疗展神经麻痹性斜视安全有效。Objective To evaluate the clinical efficacy of type A botulinum toxin injection in the treatment of early strabismus caused by abducens nerve palsy.Methods This was a retrospective case series study.Clinical data of 78 patients(78 eyes)with strabismus caused by abducens nerve palsy treated in Xuzhou First People’s Hospital from Jan.2019 to Dec.2022 were analyzed.Type A botulinum toxin was injected into the medial rectus muscle at a dose of 2.5-5.0 U based on the degree of esotropia.Esotropia degree,eye position,ocular motility,diplopia,and complications were observed after injection.The follow-up time was 6 months after injection.Results Esotropia degree decreased significantly from 27.5Δ(20.0Δ,40.0Δ)before injection to 10Δ(5Δ,10Δ)at 1,3,and 6 months after injection(all P<0.001).The rate of orthotropia was 82.05%(64/78),79.49%(62/78),and 76.92%(60/78)at 1,3,and 6 months after injection,respectively(all P<0.001).The grade of restricted ocular motility at 1,3,and 6 months after injection was significantly lower than that before injection(all P<0.001),and the proportion of grade 1 and grade 2 increased after injection.Grade 1 was 38.46%(30/78),37.18%(29/78)and 35.90%(28/78),respectively,which were significantly higher than the 6.41%(5/78)before injection.Grade 2 was 42.31%(33/78),41.03%(32/78),and 41.03%(32/78),respectively,which were significantly higher than that before injection[20.51%(16/78)].The grade of diplopia at 1,3,and 6 months after injection was significantly higher than that before injection(all P<0.001),with an increase in the proportion of disappearance and improvement of diplopia.The disappearance rate was 50.00%(39/78),44.87%(35/78),and 35.89%(28/78),respectively,which were significantly higher than that before injection.The improvement rate was 44.87%(35/78),44.87%(35/78)and 53.85%(42/78),respectively,which were significantly higher than that before injection(all P<0.001).Transient mild ptosis occurred in 6 cases,moderate ptosis in 2 cases,severe ptosis in 2 cases,and vertical diplopia<10Δ

关 键 词：肉毒毒素类 展视经疾病 麻痹 内斜视 治疗 

分 类 号：R777.41[医药卫生—眼科]