Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China.
GKT School of Medical Education, King's College London, London, London, UK.
Br J Ophthalmol. 2024 Jun 20;108(7):1044-1048. doi: 10.1136/bjo-2023-323646.
BACKGROUND/AIMS: This study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential risk factors associated with recurrence.
A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse.
A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001).
Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery.
背景/目的：本研究旨在评估肉毒毒素 A（BTXA）注射和增强剂量手术治疗急性获得性共同性内斜视（AACE）的临床疗效，并探讨与复发相关的潜在风险因素。
共纳入 104 例 2020 年 10 月至 2021 年 1 月诊断为 AACE 的患者，自愿选择增强手术或 BTXA 注射。随访评估于 2022 年 11 月结束。采用多变量线性回归分析确定影响双侧内直肌后退（MRrec）剂量反应的潜在因素。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型评估 AACE 复发的发生率和风险因素。
共 31 例 AACE 患者选择增强剂量斜视手术，73 例患者选择 BTXA 治疗。在 2 年随访期间，手术组术后结果更稳定，无复视，而 BTXA 组仅 68.68%（95%CI 55.31%至 78.79%）患者达到正位。对于接受 BTXA 治疗的患者，每天近距离工作时间被证明是 AACE 复发的一个显著风险因素（HR 1.29，95%CI 1.00 至 1.67）。增强剂量双侧 MRrec 的剂量反应与术前偏斜角度呈正相关（R=0.833；β=0.043，95%CI 0.031 至 0.055；p<0.001）。
我们的研究结果提供了定量证据，表明与 BTXA 注射相比，增强剂量手术可为 AACE 患者提供更稳定和有利的手术结果。然而，由于创伤小、操作简单、成本低、恢复快等优点，BTXA 治疗仍适用于小斜视角度的患者。
