Lawson J M, Kousoulides L, Lee J P
Moorfields Eye Hospital, London, United Kingdom.
J AAPOS. 1998 Aug;2(4):195-200. doi: 10.1016/s1091-8531(98)90052-0.
Long-term ocular alignment can be difficult to achieve in patients with consecutive and secondary (sensory) exotropia, and botulinum neurotoxin A (BTXA) is a recognized alternative to surgery in this group.
We reviewed the results of 44 patients aged 15 to 77 years (mean 31 years) who underwent their first BTXA injections from 1989 to 1990. In 30% of cases the choice of toxin treatment was made by the patient. In the remainder BTXA was recommended by the clinician to assess the risk of postoperative diplopia. Thirty-three patients (75%) were consecutively exotropic and 68% of patients had had previous strabismus surgery. The mean preinjection deviation was 41 delta of exotropia (range 12 to 85 delta exotropia) and the minimum mean angle change after 1 injection was 27 delta (range 0 to 57 delta). The average number of injections was 3 (range 1 to 17).
Of the patient group, 59% went on to strabismus surgery, 14% continued to attend for maintenance treatment, and 9% were discharged with a small, stable deviation. The remainder were either followed up elsewhere or failed to reattend.
Botulinum toxin appears to be a satisfactory treatment for constant exotropia in patients at risk of postoperative diplopia who have undergone multiple operations but, because more than half the group went on to surgery, surgery as a first therapy may be preferable in uncomplicated cases.
对于连续性和继发性（感觉性）外斜视患者而言，长期保持眼位正位可能颇具难度，而A型肉毒杆菌毒素（BTXA）是该群体中一种公认的手术替代疗法。
我们回顾了1989年至1990年间接受首次BTXA注射的44例年龄在15至77岁（平均31岁）患者的治疗结果。30%的病例中，毒素治疗方案由患者选择。其余病例中，临床医生推荐使用BTXA以评估术后复视风险。33例患者（75%）为连续性外斜视，68%的患者既往接受过斜视手术。注射前平均斜视度为41棱镜度外斜视（范围为12至85棱镜度外斜视），单次注射后最小平均角度变化为27棱镜度（范围为0至57棱镜度）。平均注射次数为3次（范围为1至17次）。
在该患者群体中，59%的患者随后接受了斜视手术，14%的患者继续接受维持治疗，9%的患者出院时斜视度小且稳定。其余患者要么在其他地方接受随访，要么未再次就诊。
对于有术后复视风险且已接受多次手术的持续性外斜视患者，肉毒杆菌毒素似乎是一种令人满意的治疗方法，但是，由于该群体中超过一半的患者随后接受了手术，对于无并发症的病例，手术作为首选治疗方法可能更为可取。
