College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Canter, Riyadh, Saudi Arabia.
Pediatric Ophthalmology Division, Pediatric Surgery Department, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
J AAPOS. 2022 Feb;26(1):16.e1-16.e6. doi: 10.1016/j.jaapos.2021.08.308. Epub 2022 Jan 10.
To compare the effect of botulinum toxin injection (BTX) to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET).
The medical records of children 1-14 years of age treated for PAET with BMR or BTX between 2010 and 2020 at a single institution were reviewed retrospectively. PAET was defined as residual esotropia of at least 14 after 6 weeks of continuous wear of full cycloplegic refraction (> +2.5 D). Success was defined as esotropia of 0-10 after a single surgery or ≥1 BTX injections.
Of 224 patients, 121 received BTX and 103 underwent BMR. BMR showed a higher success rate than BTX (70.9% vs 53.7% [P = 0.006]). BMR was more successful in males, in patients >5 years of age, and when spherical equivalent was ≤ +5.00 D (79.2%, 74.3%, and 67.5%, resp. [P < 0.05]). Mean follow-up was shorter in the BMR group than in the BTX group (16.7 ± 14.7 vs 31.4 ± 29.5 months [P = 0.0001]). Mean duration of surgery was significantly shorter in the BTX group (5.2 ± 4.3 vs 70.5 ± 31.4 min [P = 0.0001]). Postoperative inferior oblique overaction was more common in the BTX group (7.4%; P = 0.02 [Fisher exact test]), and persistent ptosis was only seen in the BTX group (0.8%); consecutive exotropia was only seen in the BMR group (2%).
In our study cohort, BMR had a higher success rate than BTX. Conventional surgery allowed for shorter follow-up and fewer complications than BTX in the treatment of PAET.
比较肉毒毒素注射（BTX）与双侧内直肌后退术（BMR）治疗部分调节性内斜视（PAET）的效果。
回顾性分析 2010 年至 2020 年在一家单机构接受 BMR 或 BTX 治疗的 1-14 岁儿童 PAET 的病历。PAET 定义为连续佩戴完全睫状肌麻痹下全矫远视镜 6 周后残余斜视度≥14 度（>+2.5 D）。手术或单次 BTX 注射后斜视度为 0-10 度为成功。
224 例患者中，121 例接受 BTX，103 例接受 BMR。BMR 的成功率高于 BTX（70.9%比 53.7%[P=0.006]）。BMR 在男性、>5 岁和等效球镜度≤+5.00 D 的患者中成功率更高（79.2%、74.3%和 67.5%，P<0.05）。BMR 组的平均随访时间短于 BTX 组（16.7±14.7 比 31.4±29.5 个月[P=0.0001]）。BTX 组的手术时间明显短于 BMR 组（5.2±4.3 比 70.5±31.4 分钟[P=0.0001]）。BTX 组术后下斜肌过强更为常见（7.4%；P=0.02[Fisher 确切检验]），仅 BTX 组出现持续性上睑下垂（0.8%），仅 BMR 组出现继发性外斜视（2%）。
在我们的研究队列中，BMR 的成功率高于 BTX。与 BTX 相比，常规手术治疗 PAET 可缩短随访时间，减少并发症。
