Murray A D
University of Cape Town, South Africa.
Aust N Z J Ophthalmol. 1989 Aug;17(3):239-45. doi: 10.1111/j.1442-9071.1989.tb00527.x.
Ten patients with sixth nerve palsy were treated with botulinum toxin injection to the antagonist nonparetic medial rectus. All patients were followed for a minimum of 14 months after the last injection. Six patients were treated within eight weeks of the onset of the palsy. Within a few days five of the six gained fusion, without the necessity of a marked head turn and none complained of confusing reversal of diplopia. The same five recovered full function. Four patients with no medial rectus contracture on forced duction testing were treated six months or longer after the onset of the palsy and none recovered full function. One of the four patients was permanently over-corrected despite persistent weakness of the lateral rectus. This preliminary report suggests that early botulinum toxin injection of patients with recent onset (acute) sixth nerve palsy is beneficial. Since some patients may recover spontaneously a randomised double-blind study is necessary to more precisely determine the effectiveness of this form of therapy. Botulinum toxin does not appear to be effective in facilitating recovery in those cases with poor lateral rectus function six months or longer after the onset of the palsy, even when there is no contracture of the medial rectus.
10例第六神经麻痹患者接受了肉毒杆菌毒素注射拮抗肌健侧内直肌治疗。所有患者在最后一次注射后至少随访14个月。6例患者在麻痹发作8周内接受治疗。几天内，6例中的5例恢复了融合功能，无需明显转头，且均未抱怨复视出现混淆性反转。同样的5例恢复了全部功能。4例在强制牵拉试验中无内直肌挛缩的患者在麻痹发作6个月或更长时间后接受治疗，无一例恢复全部功能。4例患者中有1例尽管外直肌持续无力但仍永久性过度矫正。这份初步报告表明，对近期发作（急性）的第六神经麻痹患者早期注射肉毒杆菌毒素是有益的。由于一些患者可能会自发恢复，因此有必要进行一项随机双盲研究，以更精确地确定这种治疗方式的有效性。肉毒杆菌毒素似乎对麻痹发作6个月或更长时间后外直肌功能较差的病例促进恢复无效，即使没有内直肌挛缩。
