A型肉毒毒素不同注射位置治療眼瞼痙攣的療效觀察

陸秀蘭，蔡春艷，涂惠芳

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·臨床報告·

A型肉毒毒素不同注射位置治療眼瞼痙攣的療效觀察

陸秀蘭，蔡春艷，涂惠芳

?METHODS:Eighty-five patients(136 eyes) with blepharospasm treated in our hospital between June 2012 and June 2015 were selected as the study subjects and were divided into group A (43 cases, 66 eyes) and group B (42 cases, 70 eyes) by the random number table method. Both groups were treated with type A botulinum toxin injection. Complete injection model was adopted in group A while injection sites except lower eyelid was adopted in group B. The Jankovic rating scale (JRS) scores, blepharospasm disability index (BSDI), break-up time (BUT) and tear meniscus height (TMH) before treatment and at 3wk after treatment, incidence of side effects and recurrence rate in 90d of follow-up were compared between the two groups.

?RESULTS: There were no significant differences in JRS score and BSDI between two groups before treatment (allP>0.05); 1 week after treatment, BUT and TMH increased in both groups. Three weeks after treatment, JRS scores and BSDI were lower than those before treatment (P<0.05) but there were no significant differences between groups (P>0.05). After treatment, there were no significant differences in JRS scores, BSDI and BUT between groups (P>0.05). TMH of group A was higher than that of groups B (P<0.05). Ninety days of follow-up showed that the recurrence rates in group A and group B were 14.0% and 11.9%, respectively, and the incidence rates of side effects were 23.3% and 16.7%, respectively (P>0.05).

?CONCLUSION: Both of complete injection and injection sites except lower eyelid of botulinum toxin type A in the treatment of blepharospasm can effectively relieve symptoms and the effects on daily life. The 90 d recurrence rates are similar. Injection sites except lower eyelid can reduce the interference to the stability of tear film and lacrimal fluid drainage, with slight advantage.

目的：比較A型肉毒毒素不同注射位置治療眼瞼痙攣的治療效果。

方法：選擇我院2012-06/2015-06收治的85例136眼眼瞼痙攣患者作為研究對象，按隨機數字表分為A組(43例66眼 )與B組(42例70眼)。兩組患者均應用注射用A型肉毒毒素進行治療，A組采取完全注射模式，B組采取豁免下瞼內側組模式。比較兩組患者治療前、治療后3wk的Jankovic評定量表(Jankovic Rating Scale，JRS)評分、眼瞼痙攣殘疾指數(Blepharospasm Disability Index，BSDI)指數、淚膜破裂時間(break-up time，BUT)、前段OCT淚河高度(tear meniscus height，TMH)、副反應發生率及隨訪90d復發率。

結果：兩組患者治療前的JRS評分、BSDI指數、BUT與TMH無統計學差異(均P>0.05)；治療后1wk兩組患者BUT與TMH均增大，治療后3wk兩組患者JRS評分、BSDI指數均下降，組內前后差異有統計學意義(P<0.05)；治療后兩組患者JRS評分、BSDI指數、BUT的組間差異無統計學意義(P>0.05)；A組TMH高于B組，組間差異有統計學意義(P<0.05)。90d隨訪結果顯示，A組和B組復發率分別為14.0%、11.9%，副反應發生率分別為23.3%和16.7%，兩組比較均無統計學差異(P>0.05)。

結論：A型肉毒毒素采取完全注射模式及豁免下瞼內側注射模式治療眼瞼痙攣均可有效緩解患者癥狀，并減輕其對日常生活的影響，隨訪90d復發率接近，豁免下瞼內側注射模式可減輕對淚膜穩定及淚液引流的干擾，具有微小優勢。

眼瞼痙攣；A型肉毒毒素；復發；注射位置

引用：陸秀蘭，蔡春艷，涂惠芳.A型肉毒毒素不同注射位置治療眼瞼痙攣的療效觀察.國際眼科雜志2016;16(12):2351-2353

0引言

眼瞼痙攣屬于顱面肌張力障礙性疾病，表現為眼瞼頻繁及不自主痙攣性收縮，病因尚不明確，多認為與大腦內肌張力障礙致環路功能下降有關[1]。眼瞼痙攣的傳統治療方法較多，包括藥物治療、針灸、理療等，但效果均不理想[2]。A型肉……