Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
PLoS One. 2020 Nov 12;15(11):e0241588. doi: 10.1371/journal.pone.0241588. eCollection 2020.
To investigate the efficacy of botulinum toxin injection without electromyographic guidance for the treatment of consecutive esotropia.
A retrospective study was performed on 49 subjects with consecutive esotropia who received botulinum toxin injection in the medial rectus muscles without the use of electromyographic guidance. Treatment was considered successful if the final ocular alignment was orthotropic or esodeviation was ≤10 prism diopters (PD) during distant fixation.
The mean age was 15.2 ± 8.3 years. The mean esodeviation before injection was 21.8 ± 9.1 PD at distance and 21.3 ± 8.3 PD at near. The mean number of injections per patient was 1.3 ± 0.7, and 46 patients (93.9%) received two or fewer injections. At 6 months after the final injection, the mean angle of esodeviation was 7.3 ± 6.0 PD at distance and 7.5 ± 6.6 PD at near (all p<0.001), and 69.4% showed successful alignment. By multivariate analysis, an initial postoperative esodeviation of ≤18 PD at one month after exotropia surgery was considered to be a predictive factor for successful botulinum toxin injection (P = 0.007). Vertical deviation and/or ptosis occurred in 4 patients (8.2%) at two weeks after injection, which all resolved within three months. There was no recurrence of exotropia up to the final follow-up examination.
Botulinum toxin injection without electromyographic guidance is safe and effective in the treatment of consecutive esotropia without causing recurrent exotropia. Successful botulinum toxin injection is likely in patients with an initial postoperative esodeviation of 18PD or less at one month after exotropia surgery.
探讨不使用肌电图引导的肉毒毒素注射治疗连续内斜视的疗效。
对 49 例连续内斜视患者进行回顾性研究，这些患者均接受了不使用肌电图引导的内侧直肌肉毒毒素注射治疗。如果远距固视时最终眼位为正位或内斜视度≤10 棱镜度（PD），则认为治疗成功。
患者平均年龄为 15.2±8.3 岁。注射前远距内斜视度平均值为 21.8±9.1 PD，近距内斜视度平均值为 21.3±8.3 PD。每位患者的平均注射次数为 1.3±0.7 次，46 例（93.9%）患者接受了 2 次或更少的注射。末次注射后 6 个月，远距和近距平均内斜视度分别为 7.3±6.0 PD 和 7.5±6.6 PD（均 P<0.001），69.4%的患者眼位成功。多因素分析显示，外斜视手术后 1 个月的初始术后内斜视度≤18 PD 被认为是肉毒毒素注射成功的预测因素（P=0.007）。注射后 2 周内有 4 例（8.2%）患者出现垂直斜视和/或上睑下垂，所有患者均在 3 个月内恢复。至最后一次随访检查时，无外斜视复发。
不使用肌电图引导的肉毒毒素注射治疗连续内斜视是安全有效的，不会引起外斜视复发。在外斜视手术后 1 个月初始术后内斜视度为 18 PD 或更小时，肉毒毒素注射成功的可能性更大。
