Tuğcu Betül, Sönmezay Eda, Nuhoğlu Fadime, Özdemir Hakan, Özkan Seyhan Bahar
Department of Ophthalmology, Faculty of Medicine, Dr. Bezmialem Vakif University, Istanbul, Turkey.
Department of Ophthalmology, Faculty of Medicine, Dr. Bezmialem Vakif University, Istanbul, Turkey.
J AAPOS. 2017 Apr;21(2):117-120. doi: 10.1016/j.jaapos.2017.03.008. Epub 2017 Mar 16.
To evaluate the result of using intraoperative botulinum toxin A (BTA) as an adjunct to monocular recession-resection surgery in the management of large-angle sensory strabismus.
The medical records of patients diagnosed with sensory strabismus with constant large-angle strabismus were reviewed retrospectively to identify those who underwent monocular recession-resection surgery combined with 5 units of BTA injection into the recessed muscle of the nonfixating eye. Surgical outcome was considered successful if the final deviation was within the range of 0-10.
A total of 13 patients (mean age, 31.04 ± 18.5 years) were included, 8 with exotropia and 5 with esotropia. The mean follow-up period was 52.77 ± 10.9 months. The mean preoperative deviation was 66 ± 16 in the esodeviation group and 56 ± 5 in the exodeviation group. The final postoperative mean deviation was 6 ± 7 in the esodeviation group and 6 ± 8 in the exodeviation group. There were 7 patients (87.5%) with final deviation of ≤10 in the exodeviaton group and 4 (80%) in the esodeviation group.
Adjunctive usage of BTA with conventional surgery appears to enhance surgical outcomes by increasing the amount of expected correction. The combined use of BTA with monocular recession-resection rectus muscle surgery may be a good alternative in the treatment of large-angle sensory strabismus with the advantage of less risk of potential complications compared to supramaximal surgery or surgery in the "good" eye.
评估术中使用A型肉毒杆菌毒素（BTA）辅助单眼后徙-切除术治疗大角度感觉性斜视的效果。
回顾性分析诊断为持续性大角度感觉性斜视患者的病历，以确定那些接受单眼后徙-切除术并在非注视眼的后徙肌肉中注射5单位BTA的患者。如果最终斜视度在0-10范围内，则认为手术结果成功。
共纳入13例患者（平均年龄31.04±18.5岁），其中8例为外斜视，5例为内斜视。平均随访期为52.77±10.9个月。内斜视组术前平均斜视度为66±16，外斜视组为56±5。内斜视组术后最终平均斜视度为6±7，外斜视组为6±8。外斜视组有7例（87.5%）最终斜视度≤10，内斜视组有4例（80%）。
BTA与传统手术联合使用似乎可通过增加预期矫正量来提高手术效果。BTA与单眼后徙-切除直肌手术联合使用可能是治疗大角度感觉性斜视的一种良好选择，与超最大量手术或在“好”眼进行手术相比，具有潜在并发症风险较小的优势。
