急性共同性内斜视儿童早期应用A型肉毒素注射治疗的临床观察OACSTPCD

Objective To observe the clinical effect of BTA injection in the treatment of ACE in early child-hood.Methods 59 cases of acute concomitant esotropia in children treated in our hospital from May 2020 to December 2023 were retrospectively analyzed and divided into BTA injection group(less than 6 months of onset),34 cases and extraocu-lar muscle surgery group(more than 6 months of onset),25 cases according to the different onset time.The two groups were followed up for 6 months,and the degree of strabismus was compared before surgery,1 week after surgery,1 month,3 months and 6 months.Preoperative and 6 months postoperative near stereoscopy,6 months postoperative correc-tion rate;postoperative complications.Results There was no significant difference in preoperative general situation between the two groups(all P＞0.05).The strabismus of BTA injection group was(+36.72±12.67)PD,(-2.10±5.11)PD,(+0.71±1.29)PD,(+1.94±2.23)PD,(+2.84±2.88)PD before surgery,1 week after surgery,1 month,3 months,and 6 months,respectively.The strabismus before surgery,1 week after surgery,1 month,3 months and,6 months were(+37.24±13.85)PD,(+2.32±4.71)PD,(+2.76±4.75)PD,(+2.80±4.43)PD and(+3.02±4.01)PD,respectively.The degree of strabismus in the two groups at different time points after surgery was lower than that before surgery,and the difference was statistically significant(F=95.786,P＜0.001).There was no significant difference in the degree of strabismus between the two groups before surgery,3 months after surgery and 6 months(all P＞0.05).At 6 months after surgery,all 34 patients in the BTA injection group had near stereo vision,24 patients in the extraocular muscle surgery group had near stereo vision,and 1 child did not have near stereo vision.After operation,the near stereoscopic vision in both groups was improved compared with that before operation(Z=2.087,P=0.042).There was no significant difference in near stereoscopic vision between the two groups before surgery and 6 months after surgery(all P＞0.05).Six months after surgery,88.24％(30/34)of 30 patients in the BTA injection group and 92.00％(23/25)of 23 patients in the surgery group were in the right position.There was no significant difference in the correction rate between the two groups(x2=0.378,P=0.084).At 1 week after surgery,14.71％of the 5 children in the BTA injection group had ptosis,11.76％of the 4 children had hypercorrection exotropia and mild limited internal rotation,and all of them recovered by themselves 3 months later.Conclusion BTA injection is safe and effective in the treatment of early childhood ACE with onset time less than 6 months,and can be used as a treatment plan for early onset.