Naik M N, Gangopadhyay N, Fernandes M, Murthy R, Honavar S G
Department of Ophthalmic and Facial Plastic Surgery, LV Prasad Eye Institute, Hyderabad, India.
Eye (Lond). 2008 Sep;22(9):1132-6. doi: 10.1038/sj.eye.6702866. Epub 2007 May 18.
To evaluate the effectiveness of anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox) to induce temporary ptosis for corneal protection, and assess the incidence of superior rectus underaction.
Prospective interventional case series. Patients with ocular surface pathology requiring temporary tarsorrhaphy underwent transcutaneous anterior chemodenervation of levator palpebrae superioris with Botox. The onset and duration of ptosis, corneal healing, and superior rectus underaction was evaluated.
Ten eyes of 10 patients underwent transcutaneous anterior chemodenervation of levator muscle. Five patients had Bells palsy with exposure keratopathy, four patients had persistent epithelial defect, and one had neurotrophic ulcer. The median age at presentation was 30 years. Median dose of Botulinum toxin injection was 12.5 U (range 10-15 U). The mean palpebral fissure height of 9 mm (SD+/-2.1 mm) before injection, reduced to 2.8 mm (SD+/-1.9 mm) at 1-week post-injection. More than 50% reduction in palpebral fissure height was seen in nine out of 10 eyes (90%, 95% CI 71.4-100%) at 1 week, seven of nine eyes (77.8%, 95% CI 50.6-100%) at 2 weeks, and two of nine eyes (22.2%, 95% CI 0-49.4%) at 4 weeks, and returned to pretreatment level after mean duration of 9.2 weeks (range 5-16 weeks). Superior rectus underaction was not noted in any of the patient (95% CI 0-30%). Corneal pathology improved in all cases.
Anterior chemodenervation of levator palpebrae superioris with Botulinum toxin type A (Botox) induces significant temporary ptosis and aids in corneal healing. Anterior placement of the toxin injection may avoid superior rectus underaction.
评估A型肉毒杆菌毒素（保妥适）对上睑提肌进行化学去神经支配以诱导暂时性上睑下垂来保护角膜的有效性，并评估上直肌功能不足的发生率。
前瞻性干预性病例系列研究。对需要暂时性睑裂缝合术的眼表疾病患者采用保妥适经皮对上睑提肌进行化学去神经支配。评估上睑下垂的起效时间和持续时间、角膜愈合情况以及上直肌功能不足情况。
10例患者的10只眼接受了提上睑肌经皮化学去神经支配。5例患者患有贝尔面瘫伴暴露性角膜病变，4例患者有持续性上皮缺损，1例有神经性溃疡。就诊时的中位年龄为30岁。肉毒杆菌毒素注射的中位剂量为12.5单位（范围10 - 15单位）。注射前平均睑裂高度为9毫米（标准差±2.1毫米），注射后1周降至2.8毫米（标准差±1.9毫米）。1周时，10只眼中有9只（90%，95%可信区间71.4 - 100%）睑裂高度降低超过50%；2周时，9只眼中有7只（77.8%，95%可信区间50.6 - 100%）；4周时，9只眼中有2只（22.2%，95%可信区间0 - 49.4%），平均持续9.2周（范围5 - 16周）后恢复到治疗前水平。所有患者均未出现上直肌功能不足（95%可信区间0 - 30%）。所有病例的角膜病变均有改善。
A型肉毒杆菌毒素（保妥适）对上睑提肌进行化学去神经支配可诱导明显的暂时性上睑下垂并有助于角膜愈合。毒素注射于前部可避免上直肌功能不足。
