肌腹下眶-球硅管连接术治疗固定性斜视

目的探讨在麻痹肌肌腹下行眶-球硅管连接术治疗固定性斜视的疗效。方法收集23例（23只眼）固定性斜视患者,其中内斜视22例,外斜视1例;11例为全固定性斜视,12例为亚固定性斜视（9例斜视眼可转动,但无法达到正视位,3例斜视眼转动可达到正视位）。行拮抗肌后退术后,用直径为1mm的硅管经麻痹肌腹下连接眦部眶骨膜和麻痹肌止端前巩膜。术后随访12～36个月,观察眼位和眼球运动情况。结果23例患者术后眼位均恢复至正视位。术眼可向麻痹肌侧转动达25％、50％及75％正常幅度者分别为5例、2例及3例。结论肌腹下眶-球硅管连接术借用硅胶的弹性,起到被动牵拉作用以矫正斜视,是治疗固定性斜视的可行方法,同时该手术具有硅胶不外露的优点。（中华眼科杂志,2005,41：817-820）     

眶-球硅连术治疗大幅度麻痹性斜视

目的:为探索用硅胶管作眶—球连接术治疗麻痹性斜视的疗效。方法:对已超过40°的10例(10眼)麻痹性内、外斜视的患者进行了手术,当完成拮抗肌的后退后,在外眦部眶骨膜与麻痹肌止端前巩膜或止端后巩膜进行硅胶管连接。结果:术后随访6～12月,8例眼位矫正至正视位;欠矫和过矫10°各1例。因硅胶富有弹性,所有术眼还可向麻痹肌侧转动10%～75%的幅度。结论:因在眼眶骨膜和眼球间所连接的硅胶起着一种被动牵拉作用,故该技术是矫正麻痹性斜视中可取的较好的方法之一。     

眶—球硅连术治疗固定性水平斜视

眶－球硅连术治疗固定性水平斜视钟修梁裴重刚权卫我们采用孔令媛［１］的介绍，用眶－球硅连术在内、外眦眶骨膜与麻痹肌止端后肌幅下的巩膜间用硅胶作连接，治疗了固定性内斜视６例，固定性外斜视２例。随访６～６０个月，效果满意。一、一般资料本组患者计男３例，女５...     

水平直肌移位术治疗A型斜视疗效观察

目的观察水平直肌移位术对A型斜视的治疗效果。方法对26例无明显上斜肌功能亢进的A型斜视患者行单眼或双眼水平直肌移位术,观察术前、术后眼位、眼球运动及双眼视觉情况。结果26例A型斜视患者术后A征消失23例,3例上下转眼位相差在10^△-15^△之间。结论双眼下直肌功能不足是A型斜视的重要原因。对无明显上斜肌功能亢进或上斜肌功能亢进小于＋,水平直肌移位术矫治A型斜视是一种简单有效的方法。     

下斜肌减弱术治疗先天性垂直性麻痹性斜视的临床观察

目的探讨不同术式的下斜肌减弱术在先天性垂直性麻痹性斜视中的疗效。方法对108例先天性垂直性麻痹性斜视分别行下斜肌断腱术、下斜肌截腱术、下斜肌转位术及下斜肌截腱联合同侧上直肌或对侧下直肌后徙术。结果治愈率81.5%,好转率10.2%,欠矫率5.6%,过矫率2.8%。90例头位改善或消失。32例恢复了I级视功能,9例恢复II级视功能,6例恢复了III视功能。结论下斜肌减弱术是治疗先天性垂直性麻痹性斜视的首选术式,它能有效地改善患者的外观及双眼单视功能。     

非肌电图引导注射A型肉毒毒素治疗麻痹性斜视的临床研究

目的:评价非肌电图引导Tenon氏囊下注射A型肉毒毒素治疗麻痹性斜视的效果.方法:对后天性麻痹性斜视36例(36只眼)采用直视Tenon氏囊下注射A型肉毒毒素,观察近期及远期疗效.结果:注射肌肉:内直肌30只眼,外直肌6只眼.注射剂量2.5~5.0u(平均2.35u),注射后5~14天(平均9.36天)可达最大肌肉麻痹...     

两种不同浓度的A型肉毒素注射治疗眼睑痉挛的观察对比

目的：观察两种不同浓度的A型肉毒素（ BTX－A ）治疗眼睑痉挛的疗效及不良反应。方法：将220例440眼患者（2013－01／2015－01来我科确诊为眼睑痉挛患者）随机分为高浓度组110例和低浓度组110例,分别采用40 U／mL和25 U／mL浓度局部注射到上下眼睑轮匝肌、皱眉肌、降眉肌、降眉间肌。观察两组BTX－A的用量、治疗效果、维持时间及不良反应。结果：高浓度组BTX－A的用量为48．33±4．02U,低浓度组BTX－A的用量为28．51±3．42U,差异有统计学意义（ P＜0．05）,而高浓度组与低浓度组术后疗效评估、起效时间和疗效持续时间无统计学意义（P＞0．05）,高浓度组出现不同程度上睑下垂16例,低浓度组出现2例,差异有统计学意义（P＜0．01）。两组均未出现中毒和药物过敏症状,上睑下垂发生后通常在3～6 wk内逐渐恢复,严重可以给予盐酸奈甲唑林点眼缓解。结论：两种不同浓度的BTX－A局部注射治疗眼睑痉挛的疗效是肯定的,鉴于对上睑下垂并发症的评估,推荐使用低浓度注射。     

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

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(37.9...     

A型肉毒素注射与眶周全肌切除术治疗特发性眼睑痉挛的比较

目的：比较A型肉毒素注射与眶周全肌切除术治疗特发性眼睑痉挛的疗效。
　　方法：前瞻性非随机对照试验。选取2010-12/2015-06间在我院实施A型肉毒素注射治疗的特发性眼睑痉挛患者30例60眼,同时选取年龄匹配的眶周全肌切除术治疗的特发性眼睑痉挛患者30例60眼,随访观察6mo,比较两组的疗效和复发率。
　　结果：A型肉毒素注射治疗组完全缓解、明显缓解、部分缓解和无效的眼数分别为36眼(60.0%),20眼(33.3%)、2眼(3.3%)和2眼(3.3%)。眶周全肌切除术治疗组为16眼(26.7%),24眼(40.0%)、12眼(20.0%)和8眼(13.3%),两组比较差异有统计学意义(Z=-2.968, P=0.003)。治疗6mo后两组的复发率为93.3%和20.0%,比较差异有统计学意义(χ2=32.851, P<0.001)。
　　结论：A型肉毒素注射治疗对于特发性眼睑痉挛疗效好,但6 mo后容易复发。眶周全肌切除术疗效确定且长期疗效稳定,可作为A型肉毒素注射治疗后复发的有效治疗途径。     

上斜肌减弱术矫正伴上斜肌功能亢进A型斜视82例分析

目的 探讨上斜肌减弱(断腱或后徙)术矫正伴上斜肌功能亢进A征的效果及眼球旋转状态的改变.方法 收集伴双侧上斜肌亢进的A型斜视82例,断腱术79例,后徙术3例,观察手术前后第一眼位、上下方斜视度及上斜肌亢进程度,于术前和术后1d行双眼眼底照相并测量黄斑-视盘夹角(FDA).结果 (1)断腱组:①术前A征斜度平均为(23.47±9.08)△;手术减少(25.27±11.79)△;随访期末残余斜度差为(-1.98±6.60)△,与术前比较差异有统计学意义.②术前平均FDA,右眼为(9.08±5.40)°、左眼为(12.10±4.77)°、双眼为(20.87±8.49)°;平均减少量,右眼(7.57±4.71)°、左眼(8.28±5.38)°、双眼(15.72±7.01)°;术后第1天FDA右眼(0.90±4.90)°、左眼(3.34±5.33)°、双眼(4.23±7.58)°;双眼FDA手术前、后比较,差异有统计学意义.(2)后徙组3例患者A征消失,手术矫正量为23△、35△、31△,双眼总FDA减少为24.00°、10.80°和11.00°.结论 双侧上斜肌减弱术可有效矫正A征和眼球内旋状态.断腱术A征矫正量与术前A征的度数呈正相关,术后内旋转度数减少量与术前客观旋转度数呈正相关.

Abstract：

Objective To investigate tenectomy(ST)and recession(SR),and their effects in treatment of A pattern,superior oblique overaction,and torsion.Methods Pre- and Post-operative primary eye position,upgaze and downgaze of deviation,superior oblique muscle function,fundus photograph were examined and analyzed in 82 patients of A-pattem deviation with bilateral superior oblique overaction(SOOA).Results ST ① Mean A-pattern was(23.47± 9.08)△ before and(-1.98± 6.60)△ after the operation.Mean correction was (25.27±11.79)△.② The mean pre-operative fovea-disc angle(FDA)of both eyes was(20.87± 8.49)° ,with the mean decreasing of(15.72± 7.01),and the mean FDA was(4.23± 7.58)° 1 day after operation.SR The mean correction of A pattern was 23△,35△and 31 △.The mean correction of total FDA was 24.00° ,10.80° and 11.00° .Conclusions Bilateral superior oblique weakening is effective in correcting A-pattern deviation and incyclodeviation.     

Minimally invasive botulinum toxin type A injection from the ocular surface to extraocular muscles

AIM: To investigate a new, safe and effective injection method for strabismus patients. Botulinum toxin type A (BTXA) was injected by pulling the extraocular muscles with a minimally-invasive technique into the ocular surface, and it was ensured that the extraocular muscles was maintained in the suspended state. METHODS: A total of 32 patients with different types of strabismus were treated at our institution from February to October 2010. A small conjunctival incision (≤2mm) was made under a microscope. The extraocular muscles were pulled out with a hook to ensure an elevated position compared with the wall of eyeball. The muscle fiber was clearly seen through the conjunctiva and BTXA was injected at a small angle under the microscope. The deviation angles before and after the injection were recorded. All patients were followed up at 5 and 30 days after the operation. Recovery was defined as abolition of diplopia in straight-ahead gaze and anteroinferior gaze and the symptoms of giddiness disappeared thoroughly. Eyeball position was essentially normal. Improvement was defined as basic disappearance of diplopia in straight-ahead gaze and anteroinferior gaze; restriction of action of paralytic muscle improved. If most of the symptoms and signs still existed and disturbed normal work and life, the treatment was determined to be invalid. The injection dose for patients of 5 to 10 prism diopter (PD), 11 to 20PD, and ≥21PD was 1u, 3u and 4u to 5u, respectively. RESULTS: Of the 32 treated patients, 11(34.4%) were cured, and 18(56.3%) were improved at 5 days after the operation; 12(40%) were cured, and 15(46.9%) were improved at 30 days. Five patients (15.6%) who had unsatisfactory response after BTXA injection at 30 days received repeated injections or underwent strabismus surgery. Ptosis was present in 2.5% of the injected eyes. No retrobulbar hemorrhage or ocular perforation was found in any eye. CONCLUSION: It is safe and efficient to inject BTXA by pulling extraocular muscles with a minimally-invasive technique under the microscope to make the muscles separated from the wall of eyeball.     

肉毒杆菌毒素A在斜视中的应用

肉毒杆菌毒素A(BTA)是革兰氏阳性厌氧芽胞杆菌产生的一种嗜神经外毒素，根据免疫抗原性不同分为8型(A、B、C1、C2、D、E、F和G)。BTA特异性地阻断运动神经元轴突Ca^2 依赖性、含Acb包涵小体的释放作用，出现肌肉麻痹。Scott首次将BTA应用于斜视的研究，许多学者已利用BTA治疗了多种类型的斜视、眼睑痉挛，上睑退缩等疾病，就BTA在斜视中的应用作一综述。     

眼表微创法注射A型肉毒毒素治疗斜视

目的探讨手术显微镜下微创法经球结膜行眼外肌A型肉毒毒素(botulinum toxinA,BTXA)注射,治疗不同种类斜视的可行性和安全性。方法选取2010年5月至2011年4月来我院接受BTXA治疗的18例(18眼)斜视患者,在手术显微镜下于所需注射眼外肌附着处旁切开结膜约2mm,分离并清晰暴露巩膜和肌肉止端,用斜视钩将眼外肌肉轻轻提起,注射针头走向与肌肉呈15°夹角,在显微镜直视下将BTXA注入肌肉或肌鞘内。治疗后1周和6周时随访,观察眼位、眼球运动、代偿头位、复视症状改善程度以及并发症等。结果治疗前、治疗后1周及6周时的平均斜视度数分别为22.9△、6.9△、7.7△;随访中仅1例较治疗前无改善;治疗前分别与治疗后1周及6周的斜视度数进行比较,差异均有统计学意义(均为P<0.05);治疗后1周及6周间差异无统计学意义(P>0.05)。两次复诊的斜视度数以及正位率之间差异无统计学意义(均为P>0.05)。治疗前有明显眼球运动障碍者12例经BTXA注射后均得到改善;伴复视者12例中11例经治疗正前方及前下方复视消失,1例有所改善;伴代偿头位者3例,均得到改善。2例出现上睑下垂,2例出现垂直斜视。结论手术显微镜下经球结膜微小切口对眼外肌进行BTXA注射治疗斜视,近期效果理想,安全性高,且并发症少。     

Effect of botulinum toxin on extraocular muscle proprioception

Injections of botulinum toxin type A (BoTox) in one extraocular muscle (EOM) induce long lasting paretic lengthening of the muscle permitting realignment to occur in strabismus, while eye movements appear to be unaffected after the transitory period of induced paresis. It has been hypothesized a BoTox-induced change in the spindle discharge of EOMs to explain the effect in EOM length. In decerebrate lambs and goats, first order neurons of eye muscle spindles were identified in a cellular pool located in the medial dorsolateral portion of the semilunar ganglion. The belly of the muscle to which the recorded unit belonged was infiltrated with BoTox. A decrease in afferent discharge of the spindle and in its stretch sensitivity was observed. This effect began 10–15 minutes after the injection. There was no corresponding decrease in muscle tension during the first 45 minutes. This finding suggests that the block of release of acetylcholine at motor endings is earlier and more efficacious in - than in -motoneurons. As a result of the proprioceptive input reduction, an unbalance between the agonist and antagonist muscles should occur favouring the ocular realignment.     

A型肉毒毒素治疗儿童斜视术后残余性斜颈的短期效果

目的 观察颈部注射A型肉毒毒素（BTX-A）治疗儿童斜视术后残余性斜颈的效果。设计 回顾性病例系列。研究对象 21例10岁以下因上斜肌不全麻痹行斜视矫正术后3个月以上仍存在代偿头位的患儿。方法 对残余性斜颈患儿采用体表标记定位、徒手注射法进行颈部BTX-A注射2~8个位点,总量控制在4~8 U/kg。使用头位测量仪测量患儿注射A型肉毒毒素后的头位变化,并记录家长对患儿头位改变的主观观察结果。随诊3~6个月。主要指标 头位侧屈度数及家长主观评价。结果 颈部注射BTX-A后3个月,38.1%患儿头位侧屈度数轻微改善,9.5%显著改善;家长对注射BTX-A后患儿斜颈改善情况主观评价,57.1%轻微改善,9.5%显著改善。结论 短期随访研究显示,颈部注射BTX-A治疗儿童残余性斜颈效果有限。（眼科,2015,24：258-262）     

Treatment of congenital esotropia with botulinum toxin type A

Purpose: To examine the effect of botulinum toxin type A injections given transconjunctivally into the medial recti muscles in patients with congenital esotropia. Methods: Eighty‐two patients with congenital esotropia were treated with botulinum toxin type A transconjunctival injections into the medial recti muscles. Results: A Kaplan–Meier curve shows a 24‐month success rate of 87% (n = 53) with alignment within 20 prism dioptres (PD) of the 80 patients who were seen at least 1 year following the last injection. Seven of the 80 patients underwent standard monocular surgery with recession of the medial rectus and resection of the lateral rectus muscle. Two patients were lost during follow‐up. Conclusion: Botulinum toxin type A injections into the medial recti muscles are a valuable alternative to conventional strabismus surgery.     

眼外肌注射肉毒杆菌毒素A后的形态学改变

目的 进一步观察肉毒杆菌毒素Ａ（ＢＴＡ）所致的眼外肌形态学改变并探讨其作用机制。方法 用组化３种方法（ＨＥ染色,ＢＥＳＴ卡红法,１％氯化金染色）对注射ＢＴＡ后不同时间的兔眼外肌行光镜下组织结构检查。并用透射电子显微镜观察其超微结构的变化。结果 注射ＢＴＡ后１周出现肌浆网的增多和扩张,线粒体的基质着色加深民糖原颗粒增多。注射后１月眼外肌出现肌糖原纤维的节段性痉挛。注药后两月眼外肌出现不可逆萎缩。结论     

A型肉毒毒素与眼外肌手术治疗大角度急性共同性内斜视的疗效对比

目的：探讨A型肉毒毒素(BTA)注射和眼外肌手术治疗大角度(≥+60 PD)急性共同性内斜视(AACE)的疗效差异性。

方法：回顾性分析2020-06/2022-12于我院治疗的AACE患者60例的临床资料,根据治疗方式分为2.5 IU BTA注射组(14例)、5.0 IU BTA注射组(29例)、手术组(17例)。治疗后随访6 mo,观察纳入患者屈光矫正后的斜视度、视功能、治疗有效率及BTA注射后并发症发生情况。

结果：治疗后6 mo,手术组和5.0 IU BTA注射组患者的斜视度均小于2.5 IU BTA注射组(P<0.017),但手术组与5.0 IU BTA注射组患者的斜视度无显著差异(P>0.017); 5.0 IU BTA注射组有效率高于2.5 IU BTA注射组(86% vs 43%,P<0.017); 三组患者各级视功能均无差异(P>0.05); 2.5 IU BTA注射组和5.0 IU BTA注射组治疗后并发症总发生率无显著差异(43% vs 52%,P>0.05)。

结论：对于斜视度≥+60 PD的AACE患者,双眼内直肌注射5.0 IU BTA可以取得与传统眼外肌手术相当的效果,且其具有创伤小,操作简单方便的优势。     

A 型肉毒毒素治疗先天性内斜视的疗效观察

目的 观察经结膜内直肌注射A型肉毒毒素（BTXA）治疗先天性内斜视的效果。设计 回顾性病例系列。研究对象 先天性内斜视患儿12例（24眼）,确诊年龄6~34个月（平均19.69±8.61个月）。方法 对所有患儿行眼科常规检查：包括视力、眼前节、眼底、睫状肌麻痹后的屈光度,角膜映光法和三棱镜+交替遮盖法测量33 cm 和6 m 斜视度,有屈光不正者测量裸眼及戴镜斜视度。对不能配合常规三棱镜检查的患儿,使用角膜映光法或Krimsky三棱镜法测量。在肌电放大仪引导下行双眼内直肌注射BTXA 2.5单位,注射后2周,3、6个月,1、2年和末次随访重复注射前各项检查。注射后看远斜视度≤10△作为正位标准。如果复诊到3个月斜视度持续大于20△进行第二次注射。主要指标 视力、屈光度、斜视度检查,双眼视觉功能检查。结果 12例患者就诊时等效球镜度+0.375～+3.625 D,平均（1.88±0.84） D;治疗前斜视度数+20△~+80△（平均47.91△±25.71△）,随访时间4～84个月（平均25.83±13.13个月）。8例行1次双眼内直肌注射,4例行2次双眼内直肌注射。单纯肉毒毒素注射成功率为83.33%（10/12例）。1例于注射后14个月行手术治疗,术后正位。1例注射后残留较小度数（+15△）,配戴压贴三棱镜治疗。末次随访时12例经综合治疗眼位在正常范围,4例获得正常双眼立体视功能。结论 BTXA治疗先天性内斜视短期有效,重复注射有利于维持效果。