摘要
目的 评估A型肉毒毒素注射治疗早期展神经麻痹性斜视的临床效果.方法 回顾性病例系列研究.收集分析徐州市第一人民医院眼科2019 年1 月至2022 年12 月的78 例(78 只眼)展神经麻痹性斜视患者的临床资料.根据斜视度给予内直肌A型肉毒毒素注射 2.5～5.0 U,观察注射后斜视度、眼位、眼球运动、复视及并发症情况.注射后随访 6 个月.结果 注射前斜视度 27.5Δ(20.0Δ,40.0Δ),注射后 1、3、6 个月斜视度均为 10Δ(5Δ,10Δ),均显著低于注射前(均P<0.001).注射后 1、3、6 个月正位率分别为 82.05%(64/78),79.49%(62/78),76.92%(60/78),均显著高于注射前(均P<0.001).注射后 1、3、6 个月运动受限分级,1 级分别为 38.46%(30/78)、37.18%(29/78)、35.90%(28/78),均显著高于注射前 6.41%(5/78);2 级分别为 42.31%(33/78),41.03%(32/78),41.03%(32/78),均显著高于注射前 20.51%(16/78),注射后运动受限分级均显著低于注射前(均P<0.001),注射后 1 级、2 级比例均增加.注射后 1、3、6 个月复视分级,消失率分别为 50.00%(39/78)、44.87%(35/78)、35.89%(28/78),均显著高于注射前;改善率分别为 44.87%(35/78),44.87%(35/78),53.85%(42/78),均显著高于注射前(均P<0.001).注射后出现一过性轻度上睑下垂6 例,2 例中度上睑下垂,2 例重度上睑下垂,1 例<10Δ 的垂直斜视,注射后3 个月上述症状均消失.结论 A型肉毒毒素注射治疗展神经麻痹性斜视安全有效.
Abstract
Objective To evaluate the clinical efficacy of type A botulinum toxin injection in the treatment of early strabismus caused by abducens nerve palsy.Methods This was a retrospective case series study.Clinical data of 78 patients(78 eyes)with strabismus caused by abducens nerve palsy treated in Xuzhou First People's Hospital from Jan.2019 to Dec.2022 were analyzed.Type A botulinum toxin was injected into the medial rectus muscle at a dose of 2.5-5.0 U based on the degree of esotropia.Esotropia degree,eye position,ocular motility,diplopia,and complications were observed after injection.The follow-up time was 6 months after injection.Results Esotropia degree decreased significantly from 27.5Δ(20.0Δ,40.0Δ)before injection to 10Δ(5Δ,10Δ)at 1,3,and 6 months after injection(all P<0.001).The rate of orthotropia was 82.05% (64/78),79.49% (62/78),and 76.92% (60/78)at 1,3,and 6 months after injection,respectively(all P<0.001).The grade of restricted ocular motility at 1,3,and 6 months after injection was significantly lower than that before injection(all P<0.001),and the proportion of grade 1 and grade 2 increased after injection.Grade 1 was 38.46% (30/78),37.18% (29/78)and 35.90% (28/78),respectively,which were significantly higher than the 6.41% (5/78)before injection.Grade 2 was 42.31% (33/78),41.03% (32/78),and 41.03% (32/78),respectively,which were significantly higher than that before injection[20.51% (16/78)].The grade of diplopia at 1,3,and 6 months after injection was significantly higher than that before injection(all P<0.001),with an increase in the proportion of disappearance and improvement of diplopia.The disappearance rate was 50.00% (39/78),44.87% (35/78),and 35.89% (28/78),respectively,which were significantly higher than that before injection.The improvement rate was 44.87% (35/78),44.87% (35/78)and 53.85% (42/78),respectively,which were significantly higher than that before injection(all P<0.001).Transient mild ptosis occurred in 6 cases,moderate ptosis in 2 cases,severe ptosis in 2 cases,and vertical diplopia<10Δ in 1 case after injection,all of which disappeared at 3 months after injection.Conclusion Type A botulinum toxin injection is a safe and effective method for treating strabismus caused by abducens nerve palsy.
NETL
NSTL
万方数据