Mahan Marielle, Engel J Mark
aGeorgetown University School of Medicine, Washington, District of Columbia bDivision of Pediatric Ophthalmology, Robert Wood Johnson Medical School, New Brunswick, New Jersey cWills Eye Hospital, Philadelphia, Pennsylvania, USA.
Curr Opin Ophthalmol. 2017 Sep;28(5):460-464. doi: 10.1097/ICU.0000000000000408.
The present review discusses recent advances in the use of botulinum toxin for the management of strabismus in children.
Botulinum toxin injection produces similar results compared to surgery for certain subtypes of strabismus, especially acute onset esotropia. It may be more effective in many subtypes of esotropia where surgery has been less reliable, including partially accommodative esotropia, esotropia associated with cerebral palsy, and thyroid eye disease.
Small retrospective studies have demonstrated the efficacy of botulinum toxin in the treatment of many types of pediatric strabismus, providing some guidance for clinicians to determine which patients would benefit most from this intervention. Although administration of botulinum toxin is generally accepted as a reasonable option in select cases, many strabismus surgeons have not fully embraced the treatment, in part because of perceived disadvantages compared to surgery and difficulty in identifying subsets with the highest potential for therapeutic success. A recent study compared the administration of botulinum toxin in children with acute-onset esotropia to surgical correction and found botulinum toxin had a statistically equal success rate, but with the advantage of significantly less time under general anesthesia. In addition, botulinum toxin has been recently tried in patients with partially accommodative esotropia, esotropia associated with cerebral palsy, cyclic esotropia, and in patients with thyroid eye disease. The present review will discuss current clinical recommendations based on recent studies on the use of botulinum toxin in children with strabismus.
本综述探讨肉毒杆菌毒素在儿童斜视治疗中的最新进展。
对于某些斜视亚型，尤其是急性内斜视，肉毒杆菌毒素注射与手术效果相似。在许多手术效果不太可靠的内斜视亚型中，肉毒杆菌毒素可能更有效，包括部分调节性内斜视、与脑瘫相关的内斜视以及甲状腺眼病。
小型回顾性研究已证明肉毒杆菌毒素在治疗多种小儿斜视方面的有效性，为临床医生确定哪些患者将从这种干预中获益最大提供了一些指导。尽管在某些特定情况下，肉毒杆菌毒素的应用被普遍认为是一种合理的选择，但许多斜视外科医生尚未完全接受这种治疗方法，部分原因是与手术相比存在一些明显的缺点，以及难以确定最有可能获得治疗成功的患者亚组。最近一项研究比较了急性内斜视儿童肉毒杆菌毒素注射与手术矫正的效果，发现肉毒杆菌毒素的成功率在统计学上与手术相当，但具有全身麻醉时间明显更短的优势。此外，肉毒杆菌毒素最近还被用于部分调节性内斜视、与脑瘫相关的内斜视、周期性内斜视以及甲状腺眼病患者。本综述将基于近期关于肉毒杆菌毒素在斜视儿童中应用的研究讨论当前的临床建议。
