Hakin K N, Lee J P
Moorfields Eye Hospital, London.
Eye (Lond). 1991;5 ( Pt 4):447-50. doi: 10.1038/eye.1991.72.
We have treated 12 unilaterally aphakic patients, with a manifest squint and binocular diplopia, with botulinum toxin injection to the appropriate horizontal rectus muscle, in an attempt to reduce the angle of squint and thereby resolve the diplopia. In all cases a short-term reduction in the angle of squint was achieved. In nine patients, whose aphakia was corrected with a contact lens, and eight of whom had had their lenses removed because of trauma, this reduction was only temporary. In three patients, however, who had had a non-traumatic cataract removed, replaced with a posterior chamber implant, control of the deviation was maintained long after the acute effect of the toxin had disappeared, with the development of coarse binocular single vision, a fusion range, and abolition of all diplopia. The possible reasons for these different responses are discussed and it is suggested that in cases of binocular diplopia following lens extraction, botulinum toxin treatment should be considered prior to any extraocular muscle surgery, as temporary reduction of the deviation may be sufficient to allow recovery of binocular single vision.
我们对12名单侧无晶状体且伴有明显斜视和双眼复视的患者，向适当的水平直肌注射肉毒杆菌毒素，试图减小斜视角度从而解决复视问题。所有病例均实现了斜视角度的短期减小。9例患者通过佩戴隐形眼镜矫正了无晶状体状态，其中8例因外伤摘除了晶状体，这种减小只是暂时的。然而，在3例因非创伤性白内障摘除并植入后房型人工晶状体的患者中，毒素的急性作用消失后很长时间，斜视仍得到控制，出现了粗略的双眼单视、融合范围，且所有复视消失。讨论了这些不同反应的可能原因，并建议在晶状体摘除后出现双眼复视的病例中，在进行任何眼外肌手术之前应考虑肉毒杆菌毒素治疗，因为斜视角度的暂时减小可能足以使双眼单视恢复。
