A型肉毒毒素注射剂量对小斜视度数和大斜视度数急性共同性内斜视的疗效和视功能恢复的影响

Comparison of the effects of BTA injection doses on efficacy and visual function recovery in ACE patients with small versus large angle strabismus

摘要:

目的 探讨不同A型肉毒毒素（BTA，2.5 u VS 5.0 u）注射剂量对小斜视度数（≤30 PD）和大斜视度数（30 PD）急性共同性内斜视（ACE）疗效、视功能恢复（包括同时视、近/远立体视）的影响。方法 前瞻性选取2021年1月—2024年12月在温州医科大学附属眼视光医院治疗的95例ACE患者，根据斜视度数分为A组（≤30 PD，49例）与B组（30 PD，46例），通过随机数字表法将A组与B组分为小剂量A组（24例，BTA 2.5 u）、大剂量A组（25例，BTA 5.0 u），以及小剂量B组（23例，BTA 2.5 u）、大剂量B组（23例，BTA 5.0 u）。比较不同分组斜视度数、疗效、视功能恢复、血清垂体腺苷酸环化酶激活肽（PACAP）水平等，并进行相关性分析。结果 A组与B组治疗前和治疗后1、2、3、6个月的斜视度数比较，结果 ①不同时间点斜视度数比较，差异有统计学意义（F =195.166，P =0.000）；②A组与B组斜视度数比较，差异有统计学意义（F =127.089，P =0.000）；③两组斜视度数变化趋势比较，差异有统计学意义（F =35.899，P =0.000）。小剂量A组与大剂量A组治疗前和治疗后1、2、3、6个月的斜视度数比较，结果 ①不同时间点斜视度数比较，差异有统计学意义（F =192.753，P =0.000）；②治疗后小剂量A组与大剂量A组斜视度数比较，差异有统计学意义（F =5.869，P =0.015）；③两组斜视度数变化趋势比较，差异有统计学意义（F =9.919，P =0.042）。小剂量B组与大剂量B组治疗前和治疗后1、2、3、6个月的斜视度数比较，结果 ①不同时间点斜视度数比较，差异有统计学意义（F =141.824，P =0.000）；②治疗后小剂量B组与大剂量B组斜视度数比较，差异有统计学意义（F =4.607，P =0.032）；③两组斜视度数变化趋势比较，差异有统计学意义（F =11.294，P =0.023）。大剂量B组治疗有效率和远立体视功能分布率高于小剂量B组（P 0.05）。大剂量B组治疗前后血清PACAP水平的差值大于小剂量B组（P 0.05）。B组治疗后3个月斜视度数与血清PACAP水平呈负相关（r_s =-0.294，P =0.047）。结论 小斜视度数（≤30 PD）的ACE患者首选2.5 u BTA以平衡疗效与安全性，大斜视度数（30 PD）的ACE患者需给予5.0 u BTA以获得更优疗效及视功能恢复，且高水平PACAP可能参与视功能重塑。

Abstract:

Objective To investigate the effects of different botulinum toxin type A (BTA) injection doses (2.5 u VS 5.0 u) on the efficacy and visual function recovery (including simultaneous vision and near/distance stereopsis) in patients with acute comitant esotropia (ACE) presenting with either low (≤ 30 PD) or high ( 30 PD) strabismus angles.Methods This prospective study enrolled 95 patients with ACE treated at the Eye Hospital of Wenzhou Medical University between January 2021 and December 2024. Participants were divided into group A (≤ 30 PD, 49 cases) and group B ( 30 PD, 46 cases) based on strabismus angles. Using randomized number tables, groups A and B were further subdivided into the low-dose group A (24 cases, BTA: 2.5 u) and high-dose group A (25 cases, BTA: 5.0 u), and the low-dose group B (23 cases, BTA: 2.5 u) and high-dose group B (23 cases, BTA: 5.0 u). Differences in strabismus angles, therapeutic efficacy, visual function recovery, and serum pituitary adenylate cyclase-activating peptide (PACAP) levels were compared among groups, with correlation analyses conducted.Results Comparison of strabismus angles between group A and group B patients before treatment and at 1, 2, 3, and 6 months post-treatment demonstrated that differences in strabismus angles across time points were statistically significant (F = 195.166, P = 0.000), and that differences in strabismus angles between group A and group B were statistically significant (F = 127.089, P = 0.000). Comparison of the change trend in strabismus angles between the two groups showed a statistically significant difference (F = 35.899, P = 0.000). Comparison of strabismus angles in the low-dose group A and high-dose group A before treatment and at 1, 2, 3, and 6 months post-treatment showed that they were different across the time points (F = 192.753, P = 0.000) and that they were different between the groups after treatment (F = 5.869, P = 0.015). Comparison of the change trend in strabismus angles between the two groups revealed statistically significant differences (F = 9.919, P = 0.042). Comparison of strabismus angles in the low-dose group B and high-dose group B before treatment and at 1, 2, 3, and 6 months post-treatment suggested that they differed across the time points (F = 141.824, P = 0.000) and between the groups after treatment (F = 4.607, P = 0.032). The change trend in strabismus angles between the two groups showed a statistically significant difference (F = 11.294, P = 0.023). The high-dose group B demonstrated higher treatment efficacy rates and distance stereopsis distribution rates than the low-dose group B (P 0.05). The difference in serum PACAP levels before and after treatment was greater in the high-dose group B than in the low-dose group B (P 0.05). A negative correlation was observed between the strabismus angle at 3 months post-treatment and serum PACAP levels in the group B (r_s = -0.294, P = 0.047).Conclusion For ACE patients with low strabismus angles (≤ 30 PD), 2.5 u BTA is the preferred dose to balance efficacy and safety. Patients with high strabismus angles ( 30 PD) require 5.0 u BTA to achieve superior therapeutic outcomes and visual function recovery. Elevated PACAP levels may contribute to visual function remodelling.