A型肉毒毒素在麻痹性内斜视治疗中的应用

目的　探讨A型肉毒毒素 (botulinumtoxinA ,BTXA)治疗外展神经麻痹致麻痹性内斜视(paralyticesotropia ,PE)的方法和效果。方法　将 89例PE患者分为两组 ,注射组 6 2例PE患者行BTXA眼外肌注射治疗 ,其中 16例患者在BTXA眼外肌注射治疗后 3～ 2 8个月因眼位欠矫行二期手术治疗 ;手术组 2 7例PE患者行BTXA眼外肌注射联合手术治疗。手术方法包括内直肌后退及外直肌截除术、眼外肌边缘切开及截除术、Jenson术和上下直肌转位术等。术后随访时间 3～ 33个月 ,平均 7 5个月。结果　注射组中 ,35例患者经 1～ 4次BTXA眼外肌注射治疗后眼位恢复至正位并获得双眼单视功能 ;11例患者术后眼位恢复至正位 ,矫正的平均斜视度数 (△)为 4 2 7△ ± 32 2 △ 。手术组中 ,术后14例患者眼位恢复至正位 ,矫正的平均斜视度数为 90 0 △ ± 4 0 1△ 。 14例术后患者恢复融合功能 ,双眼注视野范围为 2 0°～ 70°。结论　BTXA眼外肌注射方法可有效防止内直肌挛缩并促进外直肌肌力恢复 ,使部分患者眼位恢复至正位 ,是治疗PE的有效方法之一。同时其作为手术治疗PE的辅助措施 ,可为手术治疗奠定良好的基础

Botulinum toxin A in treatment of the sixth cranial nerve palsy

OBJECTIVE: To study the methods and the effects of botulinum toxin A (BTXA) in the treatment of paralytic esotropia (PE) due to the sixth cranial nerve palsy. METHODS: BTXA was injected into the extra-ocular muscles of 89 patients with PE. The number of injections was 1 to 5, in average 1.5. Of them, 27 patients received injections combining with surgeries at the same time, and 16 received surgeries after injections for 3 to 28 months. The procedures include recession-resection (or combining with myectomy), Jenson procedure, or vertical muscle transposition. RESULTS: Of the patients having received injections alone, 35 restored orthotropia and binocular single vision after 1 to 4 injections. Eleven patients restored to orthotropia after the injection and surgery at the second stage, and the mean correction of the strabismus degree was 42.7( triangle up ) +/- 32.2( triangle up ). Fourteen cases in the simultaneous surgical and injection group restored orthotropia after the surgery, and the mean correction of the strabismus degree was 90.0( triangle up ) +/- 40.1( triangle up ). Of them, 14 restored binocular single fusion and their range of visual fixation expanded to 20 degrees - 70 degrees. CONCLUSIONS: BTXA injected into extra-ocular muscles is an ideal therapy for the treatment of PE. Injection of BTXA during the first 6 months after the onset as a preoperative therapy may alleviate medial rectus restriction and promote the recovery of the lateral rectus functions. Some patients may restore orthotropia by injection alone. Patients under-corrected at six months after onset can be treated with surgery. Injection combined with surgery at the same time may preserve the function of medial rectus, avoid performing operation on more than two rectus, prevent the risk of anterior segment ischemia in surgery of multiple muscles and expand the field of binocular single vision as large as possible.