Nava Castañeda A, Tovilla Canales J L, Garnica Hayashi L, Velasco Y Levy A
Service d'orbite, paupières et voies lacrimales, institut d'ophtalmologie « Conde de Valenciana », Chimalpopoca 14, Ciudad de México, Mexique.
Service d'orbite, paupières et voies lacrimales, institut d'ophtalmologie « Conde de Valenciana », Chimalpopoca 14, Ciudad de México, Mexique.
J Fr Ophtalmol. 2017 Apr;40(4):279-284. doi: 10.1016/j.jfo.2016.10.016. Epub 2017 Mar 21.
To evaluate the efficacy of transconjunctival botulinum toxin type A (BTX-A) in the treatment of upper eyelid retraction in the active inflammatory phase of dysthyroid orbitopathy, establish the ideal dose, and evaluate side effects.
This is a comparative, prospective study in patients with thyroid orbitopathy, conducted at the Conde Ophthalmology Institute in Valenciana, Mexico. The patients included had dysthyroid orbitopathy in the inflammatory phase, and they were treated with subconjunctival injection of botulinum toxin type A (BTX-A) in the upper eyelid. Five units (group 1) and ten units (group 2) of BTX-A, in a single subconjunctival dose were applied to the non-dominant eye. We evaluated visual acuity, margin-to-reflex distance (RPM1), crease height, ocular motility, diplopia and keratitis, before and after administration of the toxin. The patients were followed at one, 4 and 16 weeks, with the Student t-test as a statistical analysis.
At week 4, 15 patients (100%) showed a reduced margin to reflex distance. The mean result for group 1 was -1.75mm (range -1 to -2.5mm) and group 2 was -2mm (range -1 to -4mm). Statistically significant differences were seen between pre-treatment and week 4 in both groups, but no differences between doses. Complete improvement of keratitis and lagophthalmos was observed in 5 and 2 patients, respectively. Visual acuity, ocular motility and crease height did not change in 93% of the patients. One patient (group 1) exhibited complete ptosis and vertical diplopia, which resolved spontaneously at week 6.
Transconjunctival BTX-A application is safe and effective for the treatment of eyelid retraction in dysthyroid orbitopathy. No difference was found between doses. No severe side effects were reported.
评估经结膜注射A型肉毒杆菌毒素（BTX-A）治疗甲状腺功能异常性眼眶病活动炎症期上睑退缩的疗效，确定理想剂量，并评估副作用。
这是一项在墨西哥巴伦西亚纳康德眼科研究所对甲状腺眼眶病患者进行的比较性前瞻性研究。纳入的患者患有炎症期甲状腺功能异常性眼眶病，他们接受了上睑结膜下注射A型肉毒杆菌毒素（BTX-A）治疗。将5单位（第1组）和10单位（第2组）的BTX-A以单次结膜下剂量注射到非优势眼。在注射毒素前后，我们评估了视力、边缘至反射距离（RPM1）、皱襞高度、眼球运动、复视和角膜炎情况。在第1、4和16周对患者进行随访，采用学生t检验进行统计分析。
在第4周时，15名患者（100%）的边缘至反射距离减小。第1组的平均结果为-1.75毫米（范围为-1至-2.5毫米），第2组为-2毫米（范围为-1至-4毫米）。两组在治疗前和第4周之间存在统计学显著差异，但不同剂量之间无差异。分别有5名和2名患者的角膜炎和兔眼症完全改善。93%的患者视力、眼球运动和皱襞高度未发生变化。1名患者（第1组）出现完全性上睑下垂和垂直复视，在第6周时自发缓解。
经结膜应用BTX-A治疗甲状腺功能异常性眼眶病的眼睑退缩是安全有效的。不同剂量之间未发现差异。未报告严重副作用。
