Xu Hongjia, Sun Weifeng, Dai Shuying, Cheng Yanyan, Zhao Jing, Liu Yuan, Wang Juan, Wang Ya'nan, Gao Yu, Han Huifang, Han Aijun
Department of Ophthalmology, Hebei Provincial Key Laboratory of Ophthalmology, Hebei Eye Hospital, Xingtai, Hebei Province 054000, China.
J Ophthalmol. 2020 Dec 31;2020:1702695. doi: 10.1155/2020/1702695. eCollection 2020.
To report on an improved botulinum toxin injection with conjunctival microincision for beginners, and to determine the effectiveness of botulinum toxin A (BTXA) in the treatment of patients with acute acquired comitant esotropia (AACE).
Medical records of 29 AACE patients were retrospectively analyzed. BTXA was injected into the unilateral or bilateral medial rectus muscle with conjunctival microincision without electromyographic guidance. Success was defined as total horizontal deviation ≤10 prism diopters (PD) and evidence of binocular vision.
Twenty-nine patients were included, of whom 22 were male and 7 were female. The mean age at onset was 14.2 ± 7.4 (range, 4-34) years. The mean time from onset of AACE to injection was 18.4 ± 20.3 (range, 1-96) weeks. All patients completed at least 6 months of follow-up, and the mean follow-up after BTXA injection was 12.3 ± 4.8 months (range, 7-24 months). Neurological evaluation and brain magnetic resonance imaging (MRI) were unremarkable in all patients. The mean spherical equivalent refraction was -1.22 ± 2.85D and -0.97 ± 2.80D in the right and left eyes, respectively. Mean preinjective esotropia was 38.4 ± 18.9 PD (range, +10-+80 PD) at near and 40.2 ± 17.7 PD (range, +20-+80 PD) at far distance. The mean angle of deviation at 6 months after injection was 0.6 ± 4.1 PD (range, -3-+15 PD) at near and 3.0 ± 5.9 PD (range, 0-+20 PD) at far distance. There was significant difference in the angle of deviation at near and far fixation between pre-BTXA and post-BTXA 6 months ( < 0.001, < 0.001, resp.). There was no significant difference in the angle of deviation at near and far fixation between post-BTXA 6 months and post-BTXA at final follow-up ( = 0.259 and 0.326, resp.). Mean stereoacuity improved from 338 to 88 arc seconds. During the follow-up period, 5 of 29 patients had recurrent esotropia. Two patients refused all further treatment, and the other 3 patients required incisional strabismus surgery. The success rates were 86.2% (25/29) at 6 months and 82.8% (24/29) at final follow-up.
Conjunctival microincision injection of botulinum toxin is a practical and safe method for beginners to locate an extraocular muscle, which is as effective as the traditional methods. Botulinum toxin injection can be preferred as the first-line treatment for AACE patients with potential binocular vision.
报告一种针对初学者的改良型肉毒杆菌毒素结膜微小切口注射法，并确定A型肉毒杆菌毒素（BTXA）治疗急性后天性共同性内斜视（AACE）患者的有效性。
回顾性分析29例AACE患者的病历。在无肌电图引导下，通过结膜微小切口将BTXA注射到单侧或双侧内直肌。成功定义为水平总偏斜≤10棱镜度（PD）且有双眼视觉证据。
纳入29例患者，其中男性22例，女性7例。发病时的平均年龄为14.2±7.4（范围4 - 34）岁。从AACE发病到注射的平均时间为18.4±20.3（范围1 - 96）周。所有患者均完成至少6个月的随访，BTXA注射后的平均随访时间为12.3±4.8个月（范围7 - 24个月）。所有患者的神经学评估和脑部磁共振成像（MRI）均无异常。右眼和左眼的平均等效球镜度数分别为-1.22±2.85D和-0.97±2.80D。注射前近距平均内斜视度数为38.4±18.9 PD（范围+10 - +80 PD），远距为40.2±17.7 PD（范围+20 - +80 PD）。注射后6个月近距平均偏斜角度为0.6±4.1 PD（范围-3 - +15 PD），远距为3.0±5.9 PD（范围0 - +20 PD）。BTXA注射前与注射后6个月近距和远距注视时的偏斜角度有显著差异（分别为P<0.001，P<0.001）。BTXA注射后6个月与最终随访时近距和远距注视时的偏斜角度无显著差异（分别为P = 0.259和0.326）。平均立体视锐度从338提高到88角秒。随访期间，29例患者中有5例出现内斜视复发。2例患者拒绝所有进一步治疗，其他3例患者需要进行斜视切开手术。6个月时成功率为86.2%（25/29），最终随访时为82.8%（24/29）。
结膜微小切口注射肉毒杆菌毒素是初学者定位眼外肌的一种实用且安全的方法，与传统方法效果相同。肉毒杆菌毒素注射可作为有潜在双眼视觉的AACE患者的一线治疗方法。
