功能性急性后天性共同性内斜视：A型肉毒杆菌毒素单次注射的临床特征及疗效
Functional acute acquired comitant esotropia: clinical characteristics and efficacy of single Botulinum toxin type A injection.
作者信息
Tong Luyao, Yu Xiaoning, Tang Xiajing, Zhang Yidong, Zheng Sifan, Sun Zhaohui
机构信息
Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Jiefang Road 88#, Hangzhou, 310009, Zhejiang Province, China.
Affiliated Hospital of Medical School of Ningbo University, Ningbo, Zhejiang Province, China.
出版信息
BMC Ophthalmol. 2020 Nov 25;20(1):464. doi: 10.1186/s12886-020-01739-9.
BACKGROUND
To examine the clinical features of acute acquired comitant esotropia (AACE) and to evaluate the clinical effectiveness of a single injection of botulinum toxin type A (BTXA) on binocular visual function (BVF).
METHODS
This retrospective, observational case series study enrolled patients with AACE examined from October 2018-May 2019. BTXA was injected into the both medial rectus muscles. The refractive error, best-corrected visual acuity (BCVA), stereoacuity, vergence, accommodation, the horizontal angle of deviation, and the gradient accommodative convergence/accommodation (AC/A) ratio were measured pre- and post-BTXA injection. Data pre- and postinjection were compared by the Wilcoxon signed-rank test. A Spearman correlation coefficient was calculated to explore the relationships between demographic characteristics and BVF.
RESULTS
Twenty-two AACE cases were included. Compared with preinjection deviation, the postinjection deviation in the primary position was smaller for near (p < 0.001) and distance (p < 0.001) fixation at 3 months after injection (BTXA). Furthermore, convergence was better for near (p = 0.003) and distance (p < 0.001) fixation, divergence was better for near (p = 0.021) and distance (p < 0.001) fixation, accommodation was better in the right (p = 0.011) and left (p = 0.004) eyes, and the gradient AC/A ratio was better at the third month after injection (p = 0.001). Stereoacuity was improved in 11 (50%), unchanged in 5 (22.73%) and decreased in 6 (27.27%) patients. The preinjection stereoacuity (p = 0.013, r = 0.522) and preinjection deviation for near (p = 0.015 r, = - 0.512) and distance (p = 0.009, r = - 0.541) were significantly associated with patient age.
CONCLUSIONS
AACE is characterized by a high AC/A ratio and low accommodation. A single injection of BTXA is effective for AACE. Deviation, stereoacuity, and the therapeutic effect of BTXA may be correlated with patient age.
背景
研究急性后天性共同性内斜视（AACE）的临床特征，并评估单次注射A型肉毒杆菌毒素（BTXA）对双眼视觉功能（BVF）的临床疗效。
方法
这项回顾性观察性病例系列研究纳入了2018年10月至2019年5月期间接受检查的AACE患者。将BTXA注射到双侧内直肌。在注射BTXA前后测量屈光不正、最佳矫正视力（BCVA）、立体视锐度、集合、调节、水平偏斜角度以及梯度性调节性集合/调节（AC/A）比率。注射前后的数据通过Wilcoxon符号秩检验进行比较。计算Spearman相关系数以探讨人口统计学特征与BVF之间的关系。
结果
纳入22例AACE病例。与注射前的偏斜相比，注射后3个月时，注视近距（p < 0.001）和远距（p < 0.001）时的初始位置偏斜较小。此外，注视近距（p = 0.003）和远距（p < 0.001）时集合更好，注视近距（p = 0.021）和远距（p < 0.001）时散开更好，右眼（p = 0.011）和左眼（p = 0.004）的调节更好，注射后第三个月梯度AC/A比率更好（p = 0.001）。11例（50%）患者的立体视锐度提高，5例（22.73%）患者不变，6例（27.27%）患者下降。注射前的立体视锐度（p = 0.013，r = 0.522）以及注视近距（p = 0.015，r = -0.512）和远距（p = 0.009，r = -0.541）时的注射前偏斜与患者年龄显著相关。
结论
AACE的特征是AC/A比率高和调节力低。单次注射BTXA对AACE有效。偏斜、立体视锐度以及BTXA的治疗效果可能与患者年龄相关。
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