Akbari Mohammad Reza, Ameri Ahmad, Keshtkar Jaafari Ali Reza, Mirmohammadsadeghi Arash
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Eye Research Center, Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran.
J AAPOS. 2016 Apr;20(2):126-130.e1. doi: 10.1016/j.jaapos.2016.01.007.
To evaluate the rate of and predictive factors for successful treatment of restrictive myopathy in thyroid-associated orbitopathy (TAO) using botulinum toxin injection.
Twenty patients with restrictive myopathy of TAO were enrolled in the study. Abnormal thyroid function test results were not a prerequisite for inclusion. In each extraocular muscle 25 units of botulinum toxinA were injected. The success rate, calculated at 2 years or last follow-up before surgery, was defined as proportion of the cases with esotropia of <10(Δ), vertical deviation of <5(Δ), and no diplopia in primary position and downgaze for at least 1 year. Both univariate analysis and multivariate logistic regressions were performed to identify the factors associated with success.
The procedure was successful in 11 cases (55%): in 8 patients with predominantly esotropia, 1 patient with predominantly hypotropia, and 2 patients of mixed type. Four factors were significantly associated with the success: type of deviation (P = 0.007), lower amounts of hypotropia (P = 0.001) and esotropia (P = 0.05), and lower degree of extorsion (P = 0.01). In the multivariate logistic regression, only lower amount of hypotropia was significantly associated with the success (P = 0.09, OR = 1.36).
Botulinum toxin injection can be an effective alternative for the treatment of the restrictive myopathy in TAO. The best candidates for injection of the toxin are patients with esotropia, smaller angle of horizontal and vertical deviations, and lower degree of extorsion.
评估肉毒杆菌毒素注射治疗甲状腺相关性眼病（TAO）限制性肌病的成功率及预测因素。
20例TAO限制性肌病患者纳入本研究。甲状腺功能检查结果异常并非纳入研究的必要条件。在每条眼外肌注射25单位A型肉毒杆菌毒素。在2年或手术前的最后一次随访时计算成功率，定义为内斜视<10（Δ）、垂直斜视<5（Δ）且在原在位和下视位至少1年无复视的病例比例。进行单因素分析和多因素逻辑回归以确定与成功相关的因素。
该手术在11例（55%）患者中成功：8例以内斜视为主，1例以下斜视为主，2例为混合型。四个因素与成功显著相关：斜视类型（P = 0.007）、下斜视量较少（P = 0.001）和内斜视量较少（P = 0.05）以及外旋程度较低（P = 0.01）。在多因素逻辑回归中，只有下斜视量较少与成功显著相关（P = 0.09，OR = 1.36）。
肉毒杆菌毒素注射可作为TAO限制性肌病治疗的有效替代方法。毒素注射的最佳候选者是内斜视、水平和垂直斜视角度较小以及外旋程度较低的患者。
