Alattar Sara, Saad Mohamed Sayed, Rashed Gamal El-Deen, Anwar Mohamed
Department of Ophthalmology, Faculty of Medicine, Assiut University, Assiut, Egypt.
Oman J Ophthalmol. 2024 Feb 21;17(1):84-90. doi: 10.4103/ojo.ojo_106_23. eCollection 2024 Jan-Apr.
The surgical management of large-angle concomitant esotropia is challenging with high reoperation rates. This study aims to assess the effectiveness and safety of intraoperative botulinum toxin A (BTA) augmentation compared to surgery alone in large angle concomitant esotropia.
This is a prospective randomized interventional study. Patients with large angle concomitant esotropia (≥55 prism diopter [PD]) were randomly allocated to either surgery only (Group I) or BTA augmented surgery (Group II). The surgical effect in PD/mm was calculated and compared between the study groups at all follow up intervals. Treatment was considered successful if the patients had orthotropia ± 10 PD at their final examinations.
A total of 23 patients were included in the study, 11 in Group I and 12 in group II. The surgical effect was significantly greater in Group II compared to Group I at all follow up durations. The 1-year surgical effect was 32.5% greater in Group II compared to Group I (5.99 ± 0.69 vs. 4.52 ± 0.91 PD/mm, respectively, = 0.001). The success rate was greater for Group II compared to Group I (75% vs. 63.64%, respectively), but this difference was not statistically significant ( = 0.901).
Botulinum toxin augmented surgery is a good alternative to surgery alone in the treatment of large angle concomitant esotropia. BTA injection exerts a significant augmentation effect on medial rectus muscle recessions.
大角度共同性内斜视的手术治疗具有挑战性，再次手术率较高。本研究旨在评估术中注射A型肉毒杆菌毒素（BTA）辅助手术与单纯手术相比治疗大角度共同性内斜视的有效性和安全性。
这是一项前瞻性随机干预研究。大角度共同性内斜视（≥55三棱镜度[PD]）患者被随机分为单纯手术组（I组）或BTA辅助手术组（II组）。计算并比较各研究组在所有随访时间点以PD/mm为单位的手术效果。如果患者在最终检查时眼位正位且偏差±10 PD，则认为治疗成功。
本研究共纳入23例患者，I组11例，II组12例。在所有随访期间，II组的手术效果均显著优于I组。II组1年时的手术效果比I组高32.5%（分别为5.99±0.69与4.52±0.91 PD/mm，P = 0.001）。II组的成功率高于I组（分别为75%与63.64%），但差异无统计学意义（P = 0.901）。
在治疗大角度共同性内斜视方面，肉毒杆菌毒素辅助手术是单纯手术的良好替代方案。BTA注射对内侧直肌后徙术具有显著的辅助效果。
