Wutthiphan S, Kowal L, O'Day J, Jones S, Price J
Ocular Motility Clinic, Royal Victorian Eye and Ear Hospital, Melbourne, Australia.
J Pediatr Ophthalmol Strabismus. 1997 Jul-Aug;34(4):229-34. doi: 10.3928/0191-3913-19970701-10.
To study the incidence, cause, recovery time, and prevention of diplopia following subcutaneous injection of botulinum A toxin for the treatment of facial spasms.
Patients who experienced diplopia after botulinum A toxin injections had their deviations examined in detail. When the muscle that caused diplopia was identifiable, the injection closest to that muscle was omitted in the next treatment in an attempt to prevent diplopia.
Of 250 patients receiving about 1500 sets of injections, 25 (1.7%) incidents of diplopia occurred in 10 patients. Excluding two patients who declined further treatment after having diplopia on their first botulinum A toxin treatment, seven of the remaining eight patients had multiple incidents of diplopia. The most common pattern of diplopia was "uncertain diagnosis." The most common identifiable cause of diplopia was paresis of the inferior oblique muscle. Omission of the injection into the central portion of the lower eyelids in the next treatment prevented recurrence of diplopia in only one of the four patients. No significant correlation between botulinum A toxin doses injected and times to recovery was noted.
Diplopia following botulinum A toxin treatment is uncommon. Seven patients (3% of patients studied) had 22 episodes of diplopia (88% of episodes). When diplopia occurs, it tends to recur on reinjection, sometimes with a prolonged recovery time. This response may not be dose dependent. The extraocular muscles of some patients may be more susceptible to chemodenervation than others, or botulinum A toxin may diffuse to extraocular muscles more easily in some patients than in others.
研究皮下注射A型肉毒毒素治疗面肌痉挛后复视的发生率、病因、恢复时间及预防措施。
对注射A型肉毒毒素后出现复视的患者进行详细的斜视检查。当能确定导致复视的肌肉时，下次治疗时避免在最靠近该肌肉处注射，以预防复视。
在接受约1500次注射的250例患者中，10例患者出现25次（1.7%）复视。排除2例在首次接受A型肉毒毒素治疗出现复视后拒绝进一步治疗的患者，其余8例患者中有7例出现多次复视。最常见的复视类型为“诊断不明”。最常见的可确定的复视病因是下斜肌麻痹。下次治疗时避免在下睑中央部分注射，仅4例患者中的1例复视未复发。未发现注射A型肉毒毒素剂量与恢复时间之间存在显著相关性。
A型肉毒毒素治疗后复视并不常见。7例患者（占研究患者的3%）出现22次复视发作（占发作次数的88%）。复视发生后再次注射时往往会复发，有时恢复时间延长。这种反应可能与剂量无关。部分患者的眼外肌可能比其他患者更容易受到化学去神经支配的影响，或者A型肉毒毒素在部分患者中可能比其他患者更容易扩散到眼外肌。
