From the Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
From the Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
Am J Ophthalmol. 2024 Sep;265:289-295. doi: 10.1016/j.ajo.2024.05.024. Epub 2024 May 22.
To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children.
Retrospective comparative clinical study.
The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients.
There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group (78% [35/45], 84% [38/45]) and the BMR rc group (72% [18/25], 84% [21/25]) (P = .042 for near and P = .006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the 3 surgical approaches (P = .656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group (81% [26/32]) and the BMR rc group (88% [14/16]) was higher than that in the BTX-A group (38% [5/13]; P = .004). There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P > .05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P = .017).
Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.
比较双侧内直肌注射肉毒毒素 A（BTX-A）、双侧内直肌后退手术（BMR rc）或单侧内直肌后退联合外直肌切除术（R&R）治疗部分调节性内斜视（PAET）的效果。
回顾性比较临床研究。
本研究队列包括 98 例 2014 年 12 月至 2023 年 1 月期间接受 BTX-A 注射或切开手术的 PAET 患儿。主要观察指标包括运动和感觉结果以及并发症。所有患者的随访时间均至少为 12 个月。
BTX-A 组 28 例，R&R 组 45 例，BMR rc 组 25 例。BTX-A 组远距和近距固视时的运动成功率分别为 50%（14/28）和 54%（15/28），低于 R&R 组（78%[35/45]，84%[38/45]）和 BMR rc 组（72%[18/25]，84%[21/25]）（近距 P=0.042，远距 P=0.006）。对于发病年龄<2.5 岁的患者，3 种手术方法之间无统计学差异（P=0.656）。对于发病年龄≥2.5 岁的患者，R&R 组（81%[26/32]）和 BMR rc 组（88%[14/16]）的运动成功率高于 BTX-A 组（38%[5/13]；P=0.004）。无论发病年龄或治疗方法如何，感觉结果均无统计学差异（所有 P>0.05）。随访期间，R&R 组有 4%（2/45）的患者发生继发性外斜视，BMR rc 组有 20%（5/25）的患者发生继发性外斜视；BTX-A 组无患者过矫（P=0.017）。
对于 PAET 患儿，双侧内直肌注射 BTX-A 是一种安全、可行且经济的替代方法。虽然切开手术的运动成功率更高，但对于发病年龄较早（≤2.5 岁）的患者，BTX-A 注射可能优于切开手术。在接受单侧后退-切除术治疗的大龄儿童中，发生继发性外斜视的比例较低。
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