Pharmacologic injection treatment of comitant strabismus.
Pharmacologic injection treatment of comitant strabismus.
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药理学注射治疗comitans斜肌。
DOI：
10.1016/j.jaapos.2015.11.011
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发表时间：
2016-04
期刊：
影响因子：
--
通讯作者：
Scott AB
中科院分区：
文献类型：
--
作者：
Debert I;Miller JM;Danh KK;Scott AB
报告通过在肌电图 (EMG) 引导下将布比卡因 (BPX，可选地与肾上腺素) 和 A 型肉毒杆菌毒素 (BTXA) 注射到警觉的成年受试者的眼外肌中所实现的伴随水平斜视矫正的幅度和稳定性。共有 55 名患有水平斜视的成年人参加了一项前瞻性观察性临床系列。其中，29人之前曾接受过1次或多次不成功的斜视手术； 4 人接受过其他眼眶手术。 31 名外直肌患者接受了 BPX 注射，部分患者在内直肌注射了 BTXA； 24 名患有外斜的患者在内直肌中接受了 BPX，其中一些在外直肌中接受了 BTXA。对第一次治疗后仍有残余斜视的 27 名患者进行了第二次治疗（BPX、BTXA 或两者兼有）。五名患者需要额外注射。在 6 个月时测量临床一致性，并在 5 年的随访中每年测量一次，平均随访时间为 28 个月。成功的结果定义为残余偏差≤10Δ。平均而言，23.8Δ（13.4°）的错位在 28 个月时减少了 16.0Δ（9.1°），56% 的患者获得了成功的结果。在初始错位≤25Δ的患者中，66%获得了成功的结果，平均矫正率为13.2Δ（7.5°）；在错位较大的患者中，40% 的患者获得了成功的结果，矫正平均为 20.9Δ (11.8°)。校正后的排列在长达 5 年的随访中保持稳定。注射治疗对伴随的水平斜视产生了稳定的、具有临床意义的矫正。注射为切开斜视手术提供了一种低成本的替代方案，特别是在需要最大限度地减少手术麻醉并避免眼外疤痕的情况下。
To report the magnitude and stability of corrections in comitant horizontal strabismus achieved by injecting bupivacaine (BPX, optionally with epinephrine) and botulinum A toxin (BTXA) into extraocular muscles of alert adult subjects with electromyographic (EMG) guidance. A total of 55 adults with comitant horizontal strabismus participated in a prospective observational clinical series. Of these, 29 previously had undergone 1 or more unsuccessful strabismus surgeries; 4 had undergone other orbital surgeries. Thirty-one patients with esodeviations received BPX injections in a lateral rectus muscle, some with BTXA in the medial rectus; 24 patients with exodeviations received BPX in a medial rectus muscle, some with BTXA in the lateral rectus muscle. A second treatment (BPX, BTXA, or both) was administered to 27 patients who had residual strabismus after the first treatment. Five patients required additional injections. Clinical alignment was measured at 6 months and yearly thereafter through 5 years’ follow-up, with mean follow-up of 28 months. A successful outcome was defined as residual deviation ≤10Δ. On average, presenting misalignment of 23.8Δ (13.4°) was reduced at 28 months by 16.0Δ (9.1°), with successful outcomes in 56% of patients. Of patients with initial misalignments ≤25Δ, 66% had successful outcomes, with corrections averaging 13.2Δ (7.5°); of patients with larger misalignments, 40% had successful outcomes, with corrections averaging 20.9Δ (11.8°). Corrected alignments were stable over follow-ups as long as 5 years. Injection treatments resulted in stable, clinically significant corrections in comitant horizontal strabismus. Injection provides a low-cost alternative to incisional strabismus surgery, particularly where it is desirable to minimize surgical anesthesia and avoid extraocular scarring.