A型肉毒素治疗特发性眼睑痉挛后眼表改变

目的：通过比较A型肉毒素治疗特发性眼睑痉挛前后患者眼表指标的变化，探讨其对眼表稳定性的影响。方法：前瞻性研究。收集2017年1-6月就诊于延安大学附属医院眼科门诊欲行A型肉毒素注射治疗的特发性眼睑痉挛患者，分别于注射前、注射后2周采用Jankovic量表（JRS）对其病情进行评分；采用眼表疾病指数量表（OSDI）对其眼表症状进行评分；裂隙灯显微镜观察泪膜破裂时间（BUT）和角膜荧光素钠染色情况；Schirmer Ⅰ试验测定泪液分泌量。采用配对t检验和Spearman秩相关检验对所得数据进行分析。结果：共纳入特发性眼睑痉挛患者30例（60眼），其中60%（18/30）合并干眼，且OSDI评分与JRS评分呈弱的正相关关系（r=0.278P=0.032）。所有患者经A型肉毒素注射后病情均有不同程度的缓解，JRS评分由5.5±1.0减少至0.6±1.0（t=25.730，P<0.001）。同时干眼患者中12例干眼症状也得到了缓解，OSDI评分由34.0±7.8下降为21.7±9.1（t=7.946，P<0.001）；BUT由（6.3±2.1）s增加至（8.0±2.0）s （t=4.389，P<0.001）；角膜荧光素钠染色评分也由1.0±1.0下降至0.6±0.7（t=2.963，P=0.004），治疗前后比较差异均具有统计学意义。结论：A型肉毒素注射治疗有助于缓解特发性眼睑痉挛引起的干眼。

Ocular Surface Alterations in Essential blepharospasm Patients treated with botulinum toxin A Injection

Objective: To explore the inf luence of ocular surface stability secondary to botulinum toxin A injection in patients with essential blepharospasm by comparing the changes in ocular surface indexes. Methods: In this prospective study, 30 patients with essential blepharospasm were recruited and underwent botulinum toxin A injections at the Affiliated Hospital of Yan'an University (January to June 2017). Ocular examinations,including frequency and severity of blepharospasm (using JRS chat), ocular surface symptoms (using OSDI questionnaire), tear break-up time and corneal fluorescence staining with slit-lamp examination, and tear secretion by a Schirmer Ⅰ test, were performed before and 2 weeks after botulinum toxin A injections.Results were analyzed with a paired t-test and spearman correlation test. results: Of the 30 patients (60 eyes) with essential blepharospasm who were enrolled in this study, 60%(18/30) showed dry eye symptoms, and the OSDI scores were positively correlated with JRS scores (r=0.278, P=0.032). Botulinum neurotoxin A treatment relieved blepharospasm in all the patients and JRS scores decreased from 5.5±1.0 to 0.6±1.0 (t=25.730, P<0.001). At the same time, dry eye symptoms also improved in 12 patients (12/18),and OSDI scores decreased from 34.0±7.8 to 21.7±9.1 (t=7.946, P<0.001). BUT increased from 6.3±2.1 s to 8.0±2.0 s (t=4.389, P<0.001), and corneal fluorescence staining scores decreased from 1.0±1.0 to 0.6±0.7 (t=2.963, P=0.004). All the differences were statistically significant. conclusions: Botulinum toxin A injection is effective for dry eye symptoms secondary to essential blepharospasm.