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。

Efficacy of botulinum toxin A for congenital esotropia

Objective To observe the efficacy of botulinum toxin type A （BTXA） injections transconjunctivally into the medial reeti muscles on the patients with congenital esotropia. Design Retrospective case series. Participants 12 patients （24 eyes）with congenital esotropia diagnosed at the age of 6-34 months（mean 19.69±8.61 months）. Methods Visual acuity, slitlamp, fundoscopy and eycloplegic refraction were examed. Near （33 cm） and far （6 m） horizontal deviation （in both prism degree and degrees） determined using the simultaneous prism and cover test. When cooperation was not possible, we used Hirschberg＇s or Krimsky＇s method. Concurrent bilateral medial rectus muscle BTXA injections （2.5 u） monitored with eleetromyographic recording under sedation-anesthesia were used for all the patients. Patients were followed regularly at 2 weeks, 3 months, 6 months, 1 year and 2 years till last visit. Far deviation ≤ 10△ was considered as orthophoria. During follow up, if deviation≥ 20△ and persist over 3 months, second injection will be given. Deviation and stereoscopic vision were recorded. Main Outcome Measures Best-corrected monocular visual acuity, refraction, deviation and stereoscopic vision. Results The diopter of the 12 patients was ＋0.375-＋3.625 D （mean 1.88±0.84 D）. Patients were followed up for 4 to 84 months （mean 25.83±13.13 M） after the last injection. 8 patients required once bilateral injection and 4 patients required twice bilateral injections to achieve a favorable outcome. During follow-up, success rate of BTXA injection was 83.33% （10/12 cases） . One case underwent standard surgery with recession of the medial rectus and resection of the lateral rectus muscle at the 14th month after the injection, who achieved after surgery. The other one case received prism diopters after injection since the deiviation decreased to ＋15Q Till last visit all patients achived orthophoria after combined treatment. 4 cases achieved gross stereopsis. Conclusion BTXA injectio