Department of Ophthalmology, Hospital Ramón y Cajal, Madrid, Spain.
Department of Neuroscience, Universidad Autónoma de Madrid, Madrid, Spain.
PLoS One. 2020 Feb 28;15(2):e0229267. doi: 10.1371/journal.pone.0229267. eCollection 2020.
To study the outcome of botulinum toxin (BTX) treatment (group 1) in partially accommodative esotropia with high accommodative convergence/accommodation (AC/A) ratio, in comparison with bilateral medial rectus muscles recessions and posterior fixation (group 2).
In a retrospective comparative study, children aged 3-8 years old treated between 2011 and 2016, with partially accommodative esotropia with high AC/A ratio, deviation at distance of 10 prism diopters or more, and at least 1 year of follow-up, were included. Visual acuity, alternate prism and cover test, stereoacuity, biomicroscopy, and cycloplegic retinoscopy were carried out at initial, baseline visit, 6 months and 1 year after BTX injection or surgery. Main outcome variables were deviation at distance and near, improvement in stereoacuity, and percentage of success. We used multiple regression or proportional odds analysis to control for potential confounding variables.
Of 95 patients, 84 were eligible, 48 children in group 1 and 36 in group 2. Deviation and stereoacuity were similar in the two groups at 6 months, but significantly better in the BTX group at 1 year (median distance deviation 0 prism diopters vs 5 prism diopters, p<0.01), although differences were not clinically relevant. Percentage of success was also significantly better only at 1 year (93% vs 72%, p = 0.01). Change in distance-near disparity was not significantly different in the two groups in the period of study.
Botulinum toxin could be superior to, or as effective as surgery, at middle term, in the treatment of partially accommodative esotropia with high AC/A ratio.
研究肉毒毒素（BTX）治疗（第 1 组）在高调节性集合/调节（AC/A）比率部分调节性内斜视中的疗效，与双侧内直肌后退和后固定（第 2 组）进行比较。
在一项回顾性比较研究中，纳入了 2011 年至 2016 年间治疗的年龄在 3-8 岁之间、具有高 AC/A 比率的部分调节性内斜视、远距 10 棱镜度或以上的斜视、且随访至少 1 年的儿童。在初始、基线、6 个月和 1 年后进行视力、交替棱镜和遮盖试验、立体视锐度、生物显微镜和睫状肌麻痹检影验光。主要观察变量为远距和近距斜视、立体视锐度改善和成功率。我们使用多元回归或比例优势分析来控制潜在的混杂变量。
在 95 例患者中，84 例符合条件，其中第 1 组 48 例，第 2 组 36 例。两组患儿在 6 个月时斜视和立体视锐度相似，但 BTX 组在 1 年时明显更好（中位数远距斜视 0 棱镜度对 5 棱镜度，p<0.01），尽管差异无临床意义。仅在 1 年时成功率也显著更高（93%对 72%，p=0.01）。在研究期间，两组的距离-近距差异变化无显著差异。
在中期，肉毒毒素在治疗高 AC/A 比率部分调节性内斜视方面可能优于或与手术等效。
