A型肉毒毒素在甲状腺相关眼病限制性斜视治疗中的应用

目的探讨A型肉毒毒素(BTXA)治疗甲状腺相关眼病(TAO)限制性斜视的疗效及作用特点。方法回顾性分析BTXA眼外肌注射治疗TAO限制性斜视的临床资料,在肌电图的引导下,对33例TAO限制性斜视患者的眼外肌肌腹注射BTXA,注射前后记录眼位、眼球运动、复视等情况。结果本组患者垂直斜视25例,水平斜视3例,水平斜视合并垂直斜视5例。水平斜视度平均35·00△±20·53△(20△~80△,M=27·5△),垂直斜视度29·33△±17·27△(10△~100△,M=27·5△)。随诊时间5·00~67·73个月,平均(17·04±12·77)个月。注射眼外肌61条,其中下直肌31条,内直肌16条,上直肌10条,外直肌4条。每条眼外肌平均注射次数(6·48±2·12)次,(4~11次,M=6次)。注射间隔时间0·50~26·00个月,平均(2·96±0·70)个月。注射后斜视度减小,治愈15例,有效12例,治疗无效6例。单次注射用药剂量平均(8·16±1·43)U。结论BTXA治疗TAO引起的限制性斜视效果良好。注射时机以TAO早期为佳。每次注射BTXA剂量大于麻痹性斜视和共同性斜视的用量,矫正的斜视度较低,注射的间隔时间和疗效持续时间较短,随治疗次数的增加,注射剂量需不断增大。部分患者可能免除复视而不需手术。

The application of botulinum toxin A in the treatment of restrictive strabismus in thyroid associated ophthalmopathy

OBJECTIVE: To observe the clinical effects of botulinum toxin A in the treatment of restrictive strabismus in thyroid associated ophthalmopathy (TAO). METHODS: Clinical data in 33 patients with restrictive strabismus in TAO treated with botulinum toxin A were analyzed retrospectively. Botulinum toxin A was injected into extraocular muscles guided by electromyography. Clinical data included the eye position, the eye movement and diplopia. RESULTS: There were 25 cases of vertical strabismus, 3 horizontal strabismus and 5 vertical combining horizontal strabismus in this group. The average degree of horizontal deviation was 35. 00+/-20. 53 (20 - 80 , M = 27. 59 ) , the average degree of vertical deviation was 29. 33+/-17. 27 ( 10 - 100 , M = 27. 5 ) . The average follow-up time was ( 17. 04+/-12. 77) months (5. 00+/-67. 73 months). Sixty one extraocular muscles were injected, including 31 inferior rectus, 16 medial rectus, 10 superior rectus and 4 lateral rectus. Each rectus was injected 6. 48+/-2. 12 times (4 -11times, M = 6). The interval between injections averaged (2.96+/-0. 70) months (0. 50 - 26. 00 months). The deviation degrees was decreased after injections, 15 cases were cured and did not require further surgery, 12 cases were improved and 6 cases showed poor response. The dosage for each injection averaged (8. 16+/-1. 43) U. CONCLUSIONS: Botulinum toxin A injection has a good effect in the treatment of restrictive strabismus in TAO. Better results were obtained when treated earlier. Compare with paralytic strabismus and comitant strabismus, the dosage of botulinum toxin A in each injection in TAO is higher, the mean changes of degree of deviation is slighter, the interval between injections and the duration of effect is shorter. Injection dosage should increase after repeated injections. Intolerable diplopia could be eliminated in some patients, therefore, a muscle surgery could be avoided.