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Abstract：
OBJECTIVE: To evaluate outcomes of botulinum toxin (BTX) injection of the inferior oblique (IO) muscle.
METHODS: Retrospective case series.
METHODS: Setting: Single center, ophthalmology department at Boston Children\'s Hospital.
METHODS: All patients treated with IO muscle injection of BTX (onabotulinumtoxinA) between 2010 and 2020.
METHODS: Sensorimotor evaluations at short-term (<2 months), medium-term (2-4 months), and long-term (≥4 months) intervals.
METHODS: Primary outcomes included median improvement in V-pattern strabismus and primary position hypertropia. Secondary outcomes included IO muscle overaction. Wilcoxon signed-rank tests were performed to identify differences before and after injection.
RESULTS: Record review identified 20 patients with a median age of 4.5 (range, 1-69) years. Median BTX dose injected (31 IO muscles) was 5.0 (range, 3.0-7.0) units. Indications included V-pattern strabismus (N = 8), hypertropia (N = 7), or both (N = 5). Median long-term interval was 6.4 (range, 4.1-26.6) months. Injections were concurrent with treatment of horizontal strabismus in all but 3 cases. Median V-pattern magnitude changed from 10 prism diopters (PD) preoperatively to 0 PD short-term (P = .006) and 3.5 PD long-term (P = .34). Median hypertropia changed from 8.5 PD preoperatively to 1.5 PD short-term (P = .01) and 8 PD long-term (P = .87). Median IO muscle overaction grade improved significantly at short-term (P < .001) and long-term (P = .007) intervals. There were no complications associated with the IO muscle injections.
CONCLUSIONS: BTX injection of the IO muscles can be a useful adjunct to the management of V-pattern strabismus. Intervention for primary position hypertropia may be helpful for short-term relief with no expectation of long-term benefit.
METHODS: Retrospective case series.
METHODS: Setting: Single center, ophthalmology department at Boston Children\'s Hospital.
METHODS: All patients treated with IO muscle injection of BTX (onabotulinumtoxinA) between 2010 and 2020.
METHODS: Sensorimotor evaluations at short-term (<2 months), medium-term (2-4 months), and long-term (≥4 months) intervals.
METHODS: Primary outcomes included median improvement in V-pattern strabismus and primary position hypertropia. Secondary outcomes included IO muscle overaction. Wilcoxon signed-rank tests were performed to identify differences before and after injection.
RESULTS: Record review identified 20 patients with a median age of 4.5 (range, 1-69) years. Median BTX dose injected (31 IO muscles) was 5.0 (range, 3.0-7.0) units. Indications included V-pattern strabismus (N = 8), hypertropia (N = 7), or both (N = 5). Median long-term interval was 6.4 (range, 4.1-26.6) months. Injections were concurrent with treatment of horizontal strabismus in all but 3 cases. Median V-pattern magnitude changed from 10 prism diopters (PD) preoperatively to 0 PD short-term (P = .006) and 3.5 PD long-term (P = .34). Median hypertropia changed from 8.5 PD preoperatively to 1.5 PD short-term (P = .01) and 8 PD long-term (P = .87). Median IO muscle overaction grade improved significantly at short-term (P < .001) and long-term (P = .007) intervals. There were no complications associated with the IO muscle injections.
CONCLUSIONS: BTX injection of the IO muscles can be a useful adjunct to the management of V-pattern strabismus. Intervention for primary position hypertropia may be helpful for short-term relief with no expectation of long-term benefit.
摘要：
目的：评价肉毒杆菌毒素（BTX）注射下斜肌（IO）的疗效。
方法：回顾性病例系列。
方法：设置：单中心，波士顿儿童医院眼科。
方法：所有患者均在2010年至2020年之间接受了BTX（单糖霉素A）的IO肌肉注射治疗。
方法：短期（<2个月）的感觉运动评估，中期（2-4个月），和长期（≥4个月）间隔。
方法：主要结果包括V型斜视和原发性高斜视的中位改善。次要结果包括IO肌肉过度反应。进行Wilcoxon符号秩检验以识别注射前后的差异。
结果：记录回顾确定了20例患者，中位年龄为4.5岁（范围，1-69）年。注射的BTX剂量中位数（31IO肌肉）为5.0（范围，3.0-7.0)单位。适应症包括V型斜视（N=8），高斜视（N=7），或两者(N=5)。中位长期间隔为6.4(范围，4.1-26.6)个月。除3例患者外，所有患者均同时注射治疗水平斜视。V型中值幅度从术前的10棱镜屈光度（PD）变为短期的0PD（P=.006）和长期的3.5PD（P=.34）。中位高斜视从术前的8.5PD变为短期的1.5PD（P=0.01）和长期的8PD（P=87）。在短期（P<.001）和长期（P=.007）间隔中，IO肌肉过度反应等级中位数显着改善。没有与IO肌肉注射相关的并发症。
结论：BTX注射IO肌可能是治疗V型斜视的有用辅助手段。对原发性位置过度斜视的干预可能有助于短期缓解，而不期望长期受益。
方法：回顾性病例系列。
方法：设置：单中心，波士顿儿童医院眼科。
方法：所有患者均在2010年至2020年之间接受了BTX（单糖霉素A）的IO肌肉注射治疗。
方法：短期（<2个月）的感觉运动评估，中期（2-4个月），和长期（≥4个月）间隔。
方法：主要结果包括V型斜视和原发性高斜视的中位改善。次要结果包括IO肌肉过度反应。进行Wilcoxon符号秩检验以识别注射前后的差异。
结果：记录回顾确定了20例患者，中位年龄为4.5岁（范围，1-69）年。注射的BTX剂量中位数（31IO肌肉）为5.0（范围，3.0-7.0)单位。适应症包括V型斜视（N=8），高斜视（N=7），或两者(N=5)。中位长期间隔为6.4(范围，4.1-26.6)个月。除3例患者外，所有患者均同时注射治疗水平斜视。V型中值幅度从术前的10棱镜屈光度（PD）变为短期的0PD（P=.006）和长期的3.5PD（P=.34）。中位高斜视从术前的8.5PD变为短期的1.5PD（P=0.01）和长期的8PD（P=87）。在短期（P<.001）和长期（P=.007）间隔中，IO肌肉过度反应等级中位数显着改善。没有与IO肌肉注射相关的并发症。
结论：BTX注射IO肌可能是治疗V型斜视的有用辅助手段。对原发性位置过度斜视的干预可能有助于短期缓解，而不期望长期受益。
