肉毒杆菌毒素与斜视手术治疗儿童急性获得性共同性内斜视的3年疗效比较。

IF 4.1 1区医学 Q1 OPHTHALMOLOGY

American Journal of Ophthalmology Pub Date : 2025-01-03 DOI:10.1016/j.ajo.2024.12.025

Michael T.B. Nguyen , Crystal S.Y. Cheung , David G. Hunter , Michael J. Wan , Ryan Gise

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引用次数: 0

摘要

肉毒杆菌毒素是一种替代传统斜视手术治疗急性，获得性，共同性内斜视（AACE）。先前的研究表明，这两种治疗方法在6个月内可能同样有效。我们研究的目的是确定在斜视治疗后36个月肉毒杆菌毒素是否仍然和斜视手术一样有效。方法：设计：多中心、回顾性、非随机、比较、临床、非劣效性研究。环境：两家三级儿科医院。研究人群：76名AACE患儿治疗后随访至少36个月。干预：用肉毒杆菌毒素（“BTX组”）或斜视手术（“手术组”）治疗。主要观察指标：36个月时的成功率（水平偏差小于等于10棱镜屈光度，双眼视力恢复）。结果：BTX组44例，手术组32例，两组中位偏差均为35pd（范围10-55）。结论/相关性：36个月时，在减少全身麻醉时间的情况下，肉毒杆菌毒素治疗AACE的效果不低于斜视手术。内斜视从发病到治疗的较长时间延迟是感觉运动结果恶化的独立危险因素，与治疗类型无关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Three-year Outcomes of Botulinum Toxin Versus Strabismus Surgery for the Treatment of Acute Acquired Comitant Esotropia in Children

INTRODUCTION

Botulinum toxin is an alternative to conventional strabismus surgery for treatment of acute, acquired, comitant esotropia (AACE). Previous studies suggest that the 2 treatment approaches may be equally effective for 6 months. The purpose of our study was to determine whether botulinum toxin remains as effective as strabismus surgery for 36 months after treatment.

Design

Multicenter, retrospective, nonrandomized, comparative, clinical, noninferiority study.

METHODS

Setting: Two tertiary care pediatric hospitals. Study population: 76 children with AACE followed for at least 36 months after treatment. Intervention: Treatment with either botulinum toxin (“BTX group”) or strabismus surgery (“surgery group”). Main Outcome Measure: Success rate at 36 months (horizontal deviation of 10 prism diopters or less and evidence of binocular vision).

RESULTS

There were 44 patients in the BTX group and 32 patients in the surgery group with a median deviation of 35 PD in both groups (range 10-55). The duration of general anesthesia (6 versus 71 min, P < .0001) and time in the postanesthesia care unit (40 versus 95 min, P < .0001) were significantly shorter in the BTX group. At 36 months, the success rate was 72% in the BTX group and 56% in the surgery group with a similar median deviation and median stereoacuity. BTX was noninferior to surgery at 36 months (95%CI for difference in success rate (BTX minus surgery) was −5% to +38%). At 36 months, the median time from esotropia onset to any intervention was 6.5 months without treatment success and 4 months in those with treatment success (P < .05).

CONCLUSIONS/RELEVANCE

Botulinum toxin was noninferior to strabismus surgery in the treatment of AACE at 36 months while reducing the duration of general anesthesia. Longer delay from esotropia onset to treatment was an independent risk factor for worse sensorimotor outcomes irresepctive of the type of treatment.

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来源期刊

American Journal of Ophthalmology 医学-眼科学

CiteScore

9.20

自引率

7.10%

发文量

406

审稿时长

36 days

期刊介绍： The American Journal of Ophthalmology is a peer-reviewed, scientific publication that welcomes the submission of original, previously unpublished manuscripts directed to ophthalmologists and visual science specialists describing clinical investigations, clinical observations, and clinically relevant laboratory investigations. Published monthly since 1884, the full text of the American Journal of Ophthalmology and supplementary material are also presented online at www.AJO.com and on ScienceDirect. The American Journal of Ophthalmology publishes Full-Length Articles, Perspectives, Editorials, Correspondences, Books Reports and Announcements. Brief Reports and Case Reports are no longer published. We recommend submitting Brief Reports and Case Reports to our companion publication, the American Journal of Ophthalmology Case Reports. Manuscripts are accepted with the understanding that they have not been and will not be published elsewhere substantially in any format, and that there are no ethical problems with the content or data collection. Authors may be requested to produce the data upon which the manuscript is based and to answer expeditiously any questions about the manuscript or its authors.