Paediatric Ophthalmology and Strabismus Service, Moorfields Eye Hospital NHS Foundation Trust , London.
Cairns Eye and Laser Centre , Queensland, Australia.
Strabismus. 2020 Jun;28(2):79-84. doi: 10.1080/09273972.2020.1752263. Epub 2020 May 12.
Purpose Ocular motility disturbances following retinal detachment surgery are well documented, resulting in ocular misalignment and disabling diplopia. Interestingly, there has been a downward trend over the last decade across the United Kingdom with the evolution of refined vitrectomy techniques and instrumentation. We aim to report our updated experience on factors influencing botulinum toxin outcomes in view of the trend toward vitrectomy. Methods The Moorfields strabismus service carried out a follow-up retrospective study of all subjects that received botulinum toxin for retinal surgery-related strabismus at our center over an eleven-year period. All new onset constant or intermittent strabismus following retinal detachment surgery were included. Botulinum toxin response was stratified to good and poor. Results 32 patients fulfilled our criteria, with a mean follow-up of 20 months. The majority were vitrectomised eyes (62%), presented with diplopia (60%) and exotropia (66%). All isolated and combined vertical deviations (18%) were noted among cryobuckled eyes only. Baseline largest mean horizontal deviation was 49 and 51 prism diopters (PD) among the good and poor responders, respectively. A statistically and clinically significant reduction in the horizontal angle of deviation was noted among the good ( < .0001) responders, requiring a mean of six injections, in comparison to the poor responders ( = .03). Of the good responders, five patients (16%) with decompensated phorias regained fusion control. A small number of complications (15%) were noted, the most marked being intractable diplopia in a good responder (3%) with failure to fuse. Conclusions Botulinum toxin is a useful treatment modality, particularly when surgical options are limited. It can restore binocularity in patients with preexisting fusion potential. Ocular cosmesis can be achieved but requires ongoing injections. Barriers to fusion restoration include multiple retinal surgeries, persistent macula pathology and central-peripheral retinal rivalry. This highlights the need for rigorous baseline macula assessment to allow a tailored approach when considering botulinum toxin therapy for strabismus.
视网膜脱离手术后眼球运动障碍已有相关记载，可导致眼球斜视和复视。有趣的是，在过去十年中，随着玻璃体切除术技术和仪器的不断发展，英国此类病例数量呈下降趋势。我们旨在报告我们在玻璃体切除术趋势下，与手术相关的斜视患者接受肉毒杆菌毒素治疗的最新经验，以及影响肉毒杆菌毒素治疗效果的因素。
莫尔菲尔德斜视服务中心对 11 年间在本中心接受肉毒杆菌毒素治疗视网膜手术后斜视的所有患者进行了一项回顾性随访研究。所有新发的与视网膜脱离手术后相关的恒定性或间歇性斜视患者均包含在内。将肉毒杆菌毒素的反应分为良好和不良。
32 例患者符合我们的标准，平均随访时间为 20 个月。大多数为玻璃体切除眼（62%），出现复视（60%）和外斜视（66%）。所有孤立和联合垂直偏斜（18%）均仅见于冷冻眼球。在良好和不良反应者中，基线最大平均水平偏差分别为 49 和 51 棱镜度（PD）。与不良反应者相比，良好反应者的水平斜视角度有统计学和临床意义上的显著减小（<0.0001），需要平均 6 次注射。在良好反应者中，5 例（16%）有代偿性隐斜视的患者恢复了融合控制。少数患者出现并发症（15%），最显著的是 1 例良好反应者出现无法融合的难治性复视（3%）。
肉毒杆菌毒素是一种有用的治疗方法，特别是在手术选择有限的情况下。它可以恢复有潜在融合能力的患者的双眼视。虽然可以实现眼球美容效果，但需要持续注射。融合恢复的障碍包括多次视网膜手术、持续性黄斑病变和中心-周边视网膜竞争。这突出表明需要对黄斑进行严格的基线评估，以便在考虑肉毒杆菌毒素治疗斜视时，制定有针对性的治疗方案。
