Tomsak R L, Remler B F, Averbuch-Heller L, Chandran M, Leigh R J
Division of Ophthalmology, Mount Sinai Medical Center, Cleveland, Ohio, USA.
Am J Ophthalmol. 1995 Apr;119(4):489-96. doi: 10.1016/s0002-9394(14)71236-x.
We quantified the effects of botulinum toxin injected into the retrobulbar space of patients with acquired nystagmus with prominent vertical or torsional components.
We measured binocular eye rotations in three planes before and after injection of botulinum toxin (10, 12.5, or 25 units) into the retrobulbar space of one eye of each of three patients, ages 28 to 37 years, with acquired pendular nystagmus.
Retrobulbar injection of botulinum toxin abolished or reduced all components of the nystagmus in the treated eye in all three patients for about two to three months. The patient who received 25 units developed complete external ophthalmoplegia and blepharoptosis. The other two patients retained some voluntary movements but developed diplopia. In one patient, visual acuity improved from Jaeger 5 to Jaeger 1. In a second patient, filamentary keratitis developed, and visual acuity declined from Jaeger 2 to Jaeger 7; keratitis was a recurrent problem one year after the botulinum toxin injection. In the third patient with predominantly torsional nystagmus, visual acuity was unchanged at Jaeger 2. No patient was pleased with the results, because of blepharoptosis, diplopia, or discomfort (from keratitis), and none elected to repeat the procedure.
The side effects of botulinum toxin administered by retrobulbar injection limit its therapeutic value in the treatment of acquired nystagmus. Even smaller doses that do not abolish nystagmus may produce troublesome diplopia.
我们对肉毒杆菌毒素注射到后天性眼球震颤（伴有明显垂直或扭转成分）患者的球后间隙所产生的效果进行了量化。
我们对三名年龄在28至37岁、患有后天性摆动性眼球震颤的患者，在其一只眼睛的球后间隙注射肉毒杆菌毒素（10、12.5或25单位）前后，测量了双眼在三个平面上的眼球转动情况。
球后注射肉毒杆菌毒素使所有三名患者治疗眼的眼球震颤所有成分消失或减轻，持续约两到三个月。接受25单位注射的患者出现了完全性眼外肌麻痹和上睑下垂。另外两名患者保留了一些自主运动，但出现了复视。一名患者的视力从杰格5级提高到杰格1级。另一名患者发生了丝状角膜炎，视力从杰格2级下降到杰格7级；在肉毒杆菌毒素注射一年后，角膜炎成为一个反复出现的问题。在第三名主要表现为扭转性眼球震颤的患者中，视力保持在杰格2级不变。由于上睑下垂、复视或不适（因角膜炎），没有患者对结果满意，也没有人选择重复该治疗。
球后注射肉毒杆菌毒素的副作用限制了其在后天性眼球震颤治疗中的治疗价值。即使是不消除眼球震颤的较小剂量也可能产生麻烦的复视。
