[1]张桂鸥,张璐,赵润泽,等.A型肉毒素注射与眼外肌移位术对不同时期急性共同性内斜视患者的疗效分析[J].眼科新进展,2023,43(4):303-307.[doi:10.13389/j.cnki.rao.2023.0062]
　ZHANG Guiou,ZHANG Lu,ZHAO Runze,et al.Efficacy of botulinum toxin A injection versus transposition of extraocular muscle on acute acquired concomitant esotropia in different stages[J].Recent Advances in Ophthalmology,2023,43(4):303-307.[doi:10.13389/j.cnki.rao.2023.0062]
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A型肉毒素注射与眼外肌移位术对不同时期急性共同性内斜视患者的疗效分析/HTML
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《眼科新进展》[ISSN:1003-5141/CN:41-1105/R]

卷:
43卷
期数:
2023年4期
页码:
303-307
栏目:
应用研究
出版日期:
2023-04-05

文章信息/Info

Title:
Efficacy of botulinum toxin A injection versus transposition of extraocular muscle on acute acquired concomitant esotropia in different stages
作者:
张桂鸥; 张璐; 赵润泽; 李娜敏; 周健; 郭长梅
710032　陕西省西安市，空军军医大学西京医院眼科、全军眼科研究所
Author(s):
ZHANG Guiou; ZHANG Lu; ZHAO Runze; LI Namin; ZHOU Jian; GUO Changmei
Department of Ophthalmology, Xijing Hospital, Air Force Medical University, All Army Eye Institute, Xi’an 710032, Shaanxi Province, China
关键词:
急性共同性内斜视; 不同时期; A型肉毒素; 眼外肌移位术
Keywords:
acute acquired concomitant esotropia;  different stages;  botulinum toxin A;  transposition of extraocular muscle
分类号:
R777.4
DOI:
10.13389/j.cnki.rao.2023.0062
文献标志码:
A
摘要:
目的　探讨A型肉毒素（BTA）注射与眼外肌移位术治疗不同时期的急性共同性内斜视(AACE)患者的临床疗效。
方法　回顾性分析2020年1月至12月就诊于西京医院眼科的AACE患者33例（66眼），发病6个月以内者(9例)予以BTA注射(注射组)，发病6个月及以上者(24例)予以眼外肌移位术(手术组)。记录患者一般资料，术前和术后(1周、1个月、3个月、6个月)斜视度，术前和术后6个月远、近立体视，术后6个月治愈率。重复测量数据采用重复测量数据的方差分析，计量资料比较采用非参数检验，计数资料比较采用卡方检验。
结果　两组患者间性别比例、年龄、日近用眼时长、双眼平均等效球镜度数比较差异均无统计学意义(均为P>0.05)。注射组患者术前，术后1周、1个月、3个月、6个月斜视度分别为(36.89±13.79)、(5.00±7.09)、(1.00±3.73)、(1.61±2.51)、(3.00±4.56)；手术组患者术前，术后1周、1个月、3个月、6个月斜视度分别为(37.94±19.58)、(0.65±1.34)、(1.31±1.22)、(1.98±2.20)、(2.15±1.43)，两组患者术后1周、1个月、3个月、6个月斜视度均较术前降低，差异均有统计学意义(均为P<0.001)；两组患者手术前后不同时间点斜视度组间和交互作用比较差异均无统计学意义(均为P>0.05)。术后6个月，注射组8例(88.9%)患者存在近立体视，9例(100.0%)患者存在远立体视，手术组23例(95.8%)患者存在近立体视，24例(100.0%)患者存在远立体视，两组患者术后6个月远、近立体视均较术前提高，差异均有统计学意义(均为P<0.05)；两组患者间术前及术后6个月远、近立体视比较差异均无统计学意义(均为P>0.05)。术后6个月，注射组8例(88.9%)患者斜视治愈、手术组24例(100.0%)患者斜视治愈，两组患者间术后6个月斜视治愈率比较差异无统计学意义(P>0.05)。
结论　BTA注射和眼外肌移位术均能够治疗不同时期的AACE。其中BTA注射对于发病小于6个月的患者同样效果显著，可将其作为AACE发病早期首选治疗方案。
Abstract:
Objective　To explore the clinical efficacy of botulinum toxin A (BTA) injection and transposition of extraocular muscle on acute acquired concomitant esotropia (AACE) at different stages.
Methods　A retrospective analysis was carried out on 33 AACE patients (66 eyes) who visited the Department of Ophthalmology, Xijing Hospital from January to December 2020. BTA was injected in patients whose course of disease was less than 6 months (n=9, injection group), and transposition of extraocular muscle was performed in patients whose course of disease was 6 months or longer (n=24, surgery group). The general data, preoperative and postoperative (1 week, 1 month, 3 months, and 6 months) strabismus degree (SD), preoperative and 6-month postoperative far and near stereopsis, and 6-month postoperative cure rate were observed. Variance analysis for repeated measurements was performed, measurement data were compared by a non-parametric test, and enumeration data were compared by a Chi-squared test.
Results　There was no statistically significant difference regarding gender ratio, age, daily eye usage time, and the average spherical equivalent of both eyes (all P>0.05). The SD at baseline, 1 week, 1 month, 3 months and 6 months after the treatment in the injection group were (36.89±13.79), (5.00±7.09), (1.00±3.73), (1.61±2.51) and (3.00±4.56), respectively, whereas those were (37.94±19.58), (0.65±1.34), (1.31±1.22), (1.98±2.20) and (2.15±1.43) for patients in the surgery group, respectively. The SD at 1 week, 1 month, 3 months and 6 months was lower than that at baseline in both groups, with significant differences (all P<0.001). There was no significant difference in the SD at different time points between the two groups (all P>0.05). At 6 months after the treatment, in the injection group, 8 patients (88.9%) had near stereopsis and 9 patients (100.0%) had far stereopsis; in the surgery group, 23 patients (95.8%) had near stereopsis and 24 patients (100.0%) had far stereopsis. The far and near stereopsis of patients in the two groups improved 6 months after the treatment compared with those at baseline (all P<0.05). There was no significant difference in the far and near stereopsis between the two groups before and 6 months after the treatment (all P>0.05). At 6 months after the treatment, 8 patients (88.9%) in the injection group and 24 patients (100.0%) in the surgery group were cured, with no statistically significant difference in the cure rate (P>0.05).
Conclusion　Both BTA injection and transposition of extraocular muscle are effective for AACE in different stages. BTA injection has significant efficacy for patients with a course of less than 6 months and can be used as the preferred option in the early stage of AACE.

参考文献/References:

［1］　CLARK A C,NELSON L B,SIMON J W,WAGNER R,RUBIN S E.Acute acquired comitant esotropia［J］.Br J Ophthalmol,1989,73(8):636-638.
［2］　RUATTA C,SCHIAVI C.Acute acquired concomitant esotropia associated with myopia:is the condition related to any binocular function failure?［J］.Graefes Arch Clin Exp Ophthalmol,2020,258(11):2509-2515.
［3］　刘媛.急性共同性内斜视的手术治疗［J］.眼科新进展,2009,29(6):466-467.
LIU Y.Surgical treatment for acute concomitant esotropia［J］.Rec Adv Ophthalmol,2009,29(6):466-467.
［4］　LEE H S,PARK S W,HEO H.Acute acquired comitant esotropia related to excessive Smartphone use［J］.BMC Ophthalmol,2016,16(4):37.
［5］　孟艳芳,周炼红,熊雪薇,胡学敏,叶美红,易贝茜.急性获得性共同性内斜视发病原因及临床特点探讨［J］.中国斜视与小儿眼科杂志,2019,27(4):9-12.
MENG Y F,ZHOU L H,XIONG X W,HU X M,YE M H,YI B Q.The causes and clinical characteristics of acute aquired common esotropia［J］.Chin J Strabismus Pediatr Ophthalmol,2019,27(4):9-12.
［6］　ZHENG K,HAN T,HAN Y,QU X.Acquired distance esotropia associated with myopia in the young adult［J］.BMC Ophthalmol,2018,18(1):51.
［7］　吴艳,冯雪亮,高小琴,王锦义.急性获得性共同性内斜视与过度使用智能手机关系的探讨［J］.中华眼外伤职业眼病杂志,2019,41(1):1-4.
WU Y,FENG X L,GAO X Q,WANG J Y.Research on the relationship between acute acquired comitant esotropia and excessive use of smartphone［J］.Chin J Ocul Traum Occupat Eye Dis,2019,41(1):1-4.
［8］　VAGGE A,GIANNACCARE G,SCARINCI F,CACCIAMANI A,PELLEGRINI M,BERNABEI F,et al.Acute acquired concomitant esotropia from excessive application of near vision during the COVID-19 lockdown［J］.J Pediatr Ophthalmol Strabismus,2020,57(10):e88-e91.
［9］　陈嘉煜,付晶,郝洁,李慧馨,张琼月.新冠肺炎疫情前后以医院为基础的急性共同性内斜视构成比变化研究［J］.中国斜视与小儿眼科杂志,2021,29(4):33-38.
CHEN J Y,FU J,HAO J,LI H X,ZHAO Q Y.The change in constituent ratio of acute acquired concomitant esotropia based on hospital after COVID-19 pan-demic［J］.Chin J Strabismus Pediatr Ophthalmol,2021,29(4):33-38.
［10］　MOHAN A,SEN P,MUJUMDAR D,SHAH C,JAIN E.Series of cases of acute acquired comitant esotropia in children associated with excessive online classes on smartphone during COVID-19 pandemic;digital eye strain among kids (DESK) study-3［J］.Strabismus,2021,29(3):163-167.
［11］　SPIERER A.Acute concomitant esotropia of adulthood［J］.Ophthalmology,2003,110(5):1053-1056.
［12］　CAMPOS E C.Why do the eyes cross? A review and discussion of the nature and origin of essential infantile esotropia,microstrabismus,accommodative esotropia,and acute comitant esotropia［J］.J AAPOS,2008,12(4):326-331.
［13］　SCOTT A B.Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery［J］.Ophthalmology,1980,87(10):1044-1049.
［14］　吴晓.A型肉毒毒素在麻痹性内斜视治疗中的应用［J］.中华眼科杂志,2002，38(8):12-16.
WU X.Botulinum toxin A in treatment of the sixth cranial nerve palsy［J］.Chin J Ophthalmol,2002，38(8):12-16.
［15］　王雪,吴晓.A型肉毒毒素治疗后天性共同性内斜视的近期疗效［J］.中国斜视与小儿眼科杂志,2009,17(1):1-5.
WANG X,WU X.Short-term outcome in the treatment of acquired concomitant esotropia with botulinmn toxin A［J］.Chin J Strabismus Pediatr Ophthalmol,2009,17(1):1-5.
［16］　WAN M J,MANTAGOS I S,SHAH A S,KAZLAS M,HUNTER D G.Comparison of botulinum toxin with surgery for the treatment of acute-onset comitant esotropia in children［J］.Am J Ophthalmol,2017,176(8):33-39.
［17］　LEE J.Binocular vision and ocular motility［J］.Br J Ophthalmol,1991,75(6):384.
［18］　FU T,WANG J,LEVIN M,XI P,LI D,LI J.Clinical features of acute acquired comitant esotropia in the Chinese populations［J］.Medicine (Baltimore),2017,96(46):e8528.
［19］　高淑琴,钟启明,董光美.急性共同性内斜视的手术治疗［J］.中国斜视与小儿眼科杂志,2004,12(4):161-162.
GAO S Q,ZHONG Q M,DONG G M.Surgical treatment for acute concomitant esotropia［J］.Chin J Strabismus Pediatr Ophthalmol,2004,12(4):161-162.
［20］　SHI M,ZHOU Y,QIN A,CHENG J,REN H.Treatment of acute acquired concomitant esotropia［J］.BMC Ophthalmol,2021,21(1):9.
［21］　RICCI L H,NAVAJAS S V,CARNEIRO P R,SDERBERG S A,FERRAZ C A.Ocular adverse effects after facial cosmetic procedures:a review of case reports［J］.J Cosmet Dermatol,2015,14(2):145-151.

备注/Memo

备注/Memo:
陕西省自然科学基础研究计划重点项目（编号：2021JZ-30）；西京医院学科助推计划多学科综合诊疗项目（编号：XJZT19MDT12）
更新日期/Last Update: 2023-04-05