Treating strabismus by injecting the agonist muscle with bupivacaine and the antagonist with botulinum toxin.
Treating strabismus by injecting the agonist muscle with bupivacaine and the antagonist with botulinum toxin.
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发表时间：
2009-12
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通讯作者：
A. B. Scott;Joel Miller;Kevin R Shieh
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作者：
A. B. Scott;Joel Miller;Kevin R Shieh
目的报告布比卡因（BUP）和肉毒杆菌毒素（BT）分别经激动肌和拮抗肌注射治疗水平斜视的结果。方法对7例单纯性水平斜视，2例部分性外直肌麻痹，1例老年性近视合并获得性内斜视患者的双侧水平肌注射浓度为0.75%~ 3.0%，3.0 ~ 5.0mL的BUP，拮抗剂与BT以通常治疗剂量的约一半的量一起使用，以防止其在BUP肌毒性后的再生过程中拉伸BUP处理的肌肉。我们在一名患者中重新注射了BT，该患者对初始BT剂量反应不足。结果术后193天，7例屈光不正患者平均矫正屈光度（Delta）19.7，从28.3Delta矫正到8.6Delta。在158天时，BUP注射后肌肉体积增加5.8%。1例无左后肌萎缩的左后肌麻痹患者的矫正值为55 δ，另1例左后肌萎缩的患者矫正值为4 δ。2例患者因BT注射出现一过性垂直偏离。伴有内斜视的近视患者无变化。结论：BUP和BT联合治疗7例水平斜视患者，平均矫正19.7Delta，约为单用BUP矫正的2倍。注射BUP的肌肉尺寸增加了5.8%。在2例左室无力的患者中，1例无左室萎缩，矫正55 δ，而另1例左室萎缩，矫正仅4 δ。
PURPOSE We report the results of injection of bupivacaine (BUP) and botulinum toxin (BT) into agonist and antagonist muscles, respectively, to treat horizontal strabismus. METHODS We treated both horizontal muscles of 7 patients with comitant horizontal strabismus, 2 patients with partial lateral rectus (LR) paralysis, and one elderly myopic patient with acquired esotropia, injecting the agonist muscle with BUP in concentrations of 0.75% to 3.0% and volumes of 3.0 to 5.0 mL, and the antagonist with BT in about half the usual therapeutic dose to prevent it from stretching the BUP-treated muscle during its regeneration following BUP myotoxicity. We reinjected BT in one patient who had an inadequate response from the initial BT dose. RESULTS The 7 comitant patients were corrected (on average) 19.7 prism diopters (Delta), from 28.3Delta to 8.6Delta, at 193 days after injection. Muscle volume increase after BUP injection was 5.8% at 158 days. One LR palsy patient without LR atrophy was changed 55Delta; the other, with LR atrophy, was corrected 4Delta. Two patients had transient vertical deviations from the BT injection. The myopic patient with esotropia was unchanged. CONCLUSIONS Injections of BUP and BT corrected 7 patients with comitant horizontal strabismus an average of 19.7Delta, about double the correction reported from BUP injection alone. BUP-injected muscles increased size by 5.8%. Of 2 patients with LR weakness, one without LR atrophy was changed by 55Delta, but another with LR atrophy was corrected only 4Delta.