Laria Carlos, Merino-Suárez María L, Piñero David P, Gómez-Hurtado Arantxa, Pérez-Cambrodí Rafael J
a Department of Ophthalmology , Oftalmar, Medimar International Hospital , Alicante , Spain .
b Foundation for Visual Quality (FUNCAVIS) , Alicante , Spain .
Semin Ophthalmol. 2015;30(5-6):393-6. doi: 10.3109/08820538.2014.912337. Epub 2014 May 8.
We describe the case of an eight-year-old girl with complaints of headaches and blurred vision (uncorrected visual acuity: 0.1 decimal) that showed on examination miotic pupils, pseudomyopia, no ocular motility restrictions, and no associated neurological disease. After initial treatment with cyclopentolate for two months, pseudomyopia persisted with an intermittent and variable esotropia. Spectacles of +1 both eyes and atropine 1% one drop daily were then prescribed. The situation improved and remained stable for several weeks, with pseudomyopia and esotropia reappearing later. Finally, botulinum toxin (2.5 iu Botox) was injected in the medial rectus muscle on two occasions and a visual therapy program based on the stimulation of fusional divergence, diplopia, and stereopsis consciousness was recommended. This prescription was combined with the use of atropine during the first few weeks. Orthotropia and corrected distance visual acuity of 1.0 were found three months after treatment. The evolution and clinical results of this case report suggest that botulinum toxin in combination with other therapeutic alternatives may be useful in the treatment of spasm of the near reflex.
我们描述了一名8岁女孩的病例，她主诉头痛和视力模糊（未矫正视力：小数视力0.1），检查发现瞳孔缩小、假性近视、无眼球运动受限且无相关神经系统疾病。最初用环喷托酯治疗两个月后，假性近视持续存在，并伴有间歇性且可变的内斜视。随后开具了双眼+1的眼镜和每日一滴1%阿托品的处方。情况有所改善并在数周内保持稳定，但之后假性近视和内斜视再次出现。最后，两次在内直肌注射肉毒杆菌毒素（2.5国际单位保妥适），并推荐了基于融合性散开、复视和立体视觉意识刺激的视觉治疗方案。在最初几周内，该处方与阿托品的使用相结合。治疗三个月后发现眼位正位且矫正远视力为1.0。该病例报告的病情发展和临床结果表明，肉毒杆菌毒素与其他治疗方法联合使用可能对治疗近反射痉挛有用。
