Ma Run-Ting, Hu Die-Wen-Jie, Zhou Lian-Hong, Li Wen-Ping, Li Yuan-Jin, Yi Bei-Xi
Department of Ophthalmology, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province, China.
Int J Ophthalmol. 2024 Jun 18;17(6):1094-1101. doi: 10.18240/ijo.2024.06.15. eCollection 2024.
To investigate botulinum toxin A (BTXA) efficacy on small-angle (≤25) acute acquired concomitant esotropia (AACE) in early-stage patients.
The electronic medical record data of AACE patients during March 2019 and June 2023 were collected in this retrospective and hospital-based cohort study. A total of 72 small-angle AACE patients received BTXA extraocular muscle injection. Patients were grouped by onset-to-treatment time (Group A: ≤6mo, Group B: >6mo). Deviation of esotropia, eye alignment and stereopsis were analyzed at the period of pre/post-injection (1wk, 1, 3, and 6mo). Orthophoria rate at 6mo (horizontal deviation <10 and binocular single vision) were considered as outcome index.
There were no significant baseline differences (>0.05) between two groups except onset-to-treatment time (2mo 11mo, <0.001). Higher orthophoria rates were in Group A at last follow-up (94.74% 73.53%, =0.013). Post-BTXA deviations of two groups at 1mo showed no difference (>0.05); while in 3 and 6mo Group A was significantly smaller than group B (all <0.001). No statistically significant differences were observed among all post-BTXA deviations of near and distance in Group A. In Group B, deviation at 3mo (near: 2 0, <0.001; distance: 4 0, <0.001) and 6mo (near: 6 0, <0.001; distance: 6 0, <0.001) was significant increased compared to deviation at 1wk after treatment. Group A showed better stereopsis recovery in last follow-up compared to Group B (80″ 200″, =0.002). Both groups obtained improved stereopsis after treatment (Group A: 80″ 300″, <0.001; Group B: 200″ 300″, =0.037).
BTXA is effective for AACE with small deviation (≤25) in early stage. Delayed treatment (>6mo) may reduce BTXA efficacy. Early BTXA intervention benefits long-term eye alignment and stereopsis recovery.
探讨A型肉毒毒素（BTXA）对早期小角度（≤25）急性后天性共同性内斜视（AACE）患者的疗效。
本回顾性医院队列研究收集了2019年3月至2023年6月期间AACE患者的电子病历数据。共有72例小角度AACE患者接受了BTXA眼外肌注射。患者按发病至治疗时间分组（A组：≤6个月，B组：>6个月）。在注射前/后（1周、1、3和6个月）分析内斜视偏差、眼位矫正和立体视。将6个月时的正位率（水平偏差<10且双眼单视）作为结局指标。
除发病至治疗时间外（2个月对11个月；<0.001），两组间基线无显著差异（>0.05）。最后一次随访时，A组的正位率更高（94.74%对73.53%；P = 0.013）。两组在注射BTXA后1个月时的偏差无差异（>0.05）；而在3个月和6个月时，A组明显小于B组（均<0.001）。A组注射BTXA后近距和远距的所有偏差之间未观察到统计学显著差异。在B组中，与治疗后1周时的偏差相比，3个月时（近距：2△对0△；<0.001；远距：4△对0△；<0.001）和6个月时（近距：6△对0△；<0.001；远距：6△对0△；<0.001）的偏差显著增加。与B组相比，A组在最后一次随访时立体视恢复更好（80″对200″；P = 0.002）。两组治疗后立体视均有改善（A组：80″对300″；<0.001；B组：200″对300″；P = 0.037）。
BTXA对早期小角度偏差（≤25）的AACE有效。延迟治疗（>6个月）可能会降低BTXA的疗效。早期BTXA干预有利于长期眼位矫正和立体视恢复。
