Department of Ophthalmology, Ankara Bilkent City Hospital, Ankara, Turkey.
Department of Neurology, Ankara Bilkent City Hospital, Ankara, Turkey.
Int Ophthalmol. 2022 Aug;42(8):2625-2632. doi: 10.1007/s10792-022-02253-1. Epub 2022 Mar 30.
To investigate the effect of botulinum neurotoxin-A (BTX-A) treatment on dry eye symptoms, tear meniscus, corneal topography and corneal aberrometry in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS).
This prospective study comprised of 6 patients with BEB and 20 patients with HFS. Tear meniscus height (TMH) and depth (TMD), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), Schirmer I test, ocular surface disease index (OSDI) score, corneal topography [corneal power of flat axis (K1), corneal power of steep axis (K2), mean corneal power (Km), astigmatism and thinnest pachymetry] and anterior corneal aberrometry [spherical aberration (SA), vertical coma (vcoma), horizontal coma (hcoma), higher order root mean square (hRMS) and total RMS] were evaluated before BTX-A treatment, 3 weeks after BTX-A treatment and 2 months after BTX-A treatment.
Six patients with BEB and 20 patients with HFS treated with BTX-A were evaluated in this study. Twenty contralateral spasm free eyes of 20 HFS patients were taken as control group. TMH and TMD were found to be significantly higher in eyes with spasm at both 3 weeks and 2 months after injection (TMH: 279.0 ± 123.2 at pretreatment, 380.5 ± 174.7 at third week and 317.0 ± 125.5 at second month p < 0.001 and p = 0.02, respectively), (TMD: 183.7 ± 59.7 at pretreatment, 235.7 ± 91.1 at third week and 209.8 ± 77.1 at second month p < 0.01 and p = 0.015, respectively). TBUT, CFSS, Schirmer I test values were similar (p > 0.05). OSDI scores decreased significantly from 29.6 ± 25.3 to 19.8 ± 20. p = 0.03 at third week and increased again by second month. K2 (43.9 ± 1.7 vs. 43.7 ± 1.6, p = 0.03) and astigmatism (0.8 ± 0.5 vs. 0.6 ± 0.4, p = 0.04) values were significantly lower at third week and increased again by second month. Pachymetry and aberrometric values did not change significantly. In the control group only Schirmer I test value decreased significantly at second month (10.5 ± 6.5 vs. 7.2 ± 5.6, p = 0.008), other parameters did not change.
BTX-A injection increases tear meniscus and decrease symptoms related to dry eye disease in BEB and HFS patients. It decrease astigmatism and keratometry values, it does not cause a significant change in corneal aberrations. However the positive effects of BTX-A injection on ocular surface is temporary.
研究肉毒毒素-A（BTX-A）治疗对良性特发性眼睑痉挛（BEB）和半面痉挛（HFS）患者干眼症状、泪膜新月形、角膜地形图和角膜像差的影响。
本前瞻性研究包括 6 例 BEB 患者和 20 例 HFS 患者。评估泪膜新月形高度（TMH）和深度（TMD）、泪膜破裂时间（TBUT）、角膜荧光素染色评分（CFSS）、Schirmer I 试验、眼表疾病指数（OSDI）评分、角膜地形图[角膜平坦轴的角膜屈光力（K1）、角膜陡轴的角膜屈光力（K2）、平均角膜屈光力（Km）、散光和最薄角膜厚度]和前角膜像差[球差（SA）、垂直彗差（vcoma）、水平彗差（hcoma）、高阶均方根（hRMS）和总 RMS]，在 BTX-A 治疗前、治疗后 3 周和治疗后 2 个月进行评估。
本研究评估了 6 例 BEB 患者和 20 例 HFS 患者接受 BTX-A 治疗。20 例 HFS 患者的 20 只对侧无痉挛眼作为对照组。注射后 3 周和 2 个月，痉挛眼的 TMH 和 TMD 均显著升高（TMH：治疗前 279.0±123.2，治疗后第 3 周 380.5±174.7，第 2 个月 317.0±125.5，p<0.001，p=0.02），（TMD：治疗前 183.7±59.7，治疗后第 3 周 235.7±91.1，第 2 个月 209.8±77.1，p<0.01，p=0.015）。TBUT、CFSS、Schirmer I 试验值相似（p>0.05）。OSDI 评分从 29.6±25.3 显著降至第 3 周的 19.8±20.，p=0.03，第 2 个月再次升高。K2（43.9±1.7 与 43.7±1.6，p=0.03）和散光（0.8±0.5 与 0.6±0.4，p=0.04）值在第 3 周较低，第 2 个月再次升高。角膜厚度和像差值无明显变化。对照组仅 Schirmer I 试验值在第 2 个月显著下降（10.5±6.5 与 7.2±5.6，p=0.008），其他参数无变化。
BTX-A 注射可增加 BEB 和 HFS 患者的泪膜新月形并减轻与干眼相关的症状。它降低了散光和角膜曲率值，但不会导致角膜像差的显著变化。然而，BTX-A 注射对眼表的积极影响是暂时的。
