目的:研究A型肉毒神经毒素(BTX-A)治疗对干眼症状的影响,撕裂半月板,良性原发性眼睑痉挛(BEB)和面肌痉挛(HFS)患者的角膜地形图和角膜像差测定。
方法:这项前瞻性研究包括6例BEB患者和20例HFS患者。撕裂弯月面高度(TMH)和深度(TMD),泪液破裂时间(TBUT),角膜荧光素染色评分(CFSS),Schirmer我测试,眼表疾病指数(OSDI)评分,角膜地形图[角膜平轴屈光力(K1),陡峭轴的角膜屈光力(K2),平均角膜屈光力(Km),散光和最薄厚度测量]和前角膜像差测量[球面像差(SA),垂直昏迷(肉瘤),水平昏迷(昏迷),在BTX-A治疗前评估高阶均方根(hRMS)和总RMS],BTX-A治疗后3周和BTX-A治疗后2个月。
结果:本研究评估了6例BEB患者和20例HFS患者接受BTX-A治疗。以20例HFS患者的20例对侧无痉挛眼作为对照组。在注射后3周和2个月时,有痉挛的眼睛中TMH和TMD均显着升高(TMH:治疗前279.0±123.2,在第三周为380.5±174.7,在第二个月为317.0±125.5,p分别<0.001和p=0.02),(TMD:预处理时183.7±59.7,第三周为235.7±91.1,第二个月为209.8±77.1,分别为p<0.01和p=0.015)。TBUT,CFSS,SchirmerI测试值相似(p>0.05)。OSDI评分从29.6±25.3降至19.8±20。第三周p=0.03,第二个月再次增加。K2(43.9±1.7vs.43.7±1.6,p=0.03)和散光(0.8±0.5vs.0.6±0.4,p=0.04)值在第三周显着降低,到第二个月再次增加。测径和像差值没有明显变化。对照组仅SchirmerI试验值在第2个月时显著下降(10.5±6.5vs.7.2±5.6,p=0.008),其他参数没有变化。
结论:BTX-A注射液可增加BEB和HFS患者的泪液半月板并减轻与干眼病相关的症状。它降低了散光和角膜曲率测量值,它不会引起角膜像差的显著变化。然而,BTX-A注射对眼表的积极作用是暂时的。
OBJECTIVE: To investigate the effect of botulinum neurotoxin-A (BTX-A) treatment on dry eye symptoms, tear meniscus, corneal topography and corneal aberrometry in patients with benign essential blepharospasm (BEB) and hemifacial spasm (HFS).
METHODS: This prospective study comprised of 6 patients with BEB and 20 patients with HFS. Tear meniscus height (TMH) and depth (TMD), tear break-up time (TBUT), corneal fluorescein staining score (CFSS), Schirmer I test, ocular surface disease index (OSDI) score, corneal topography [corneal power of flat axis (K1), corneal power of steep axis (K2), mean corneal power (Km), astigmatism and thinnest pachymetry] and anterior corneal aberrometry [spherical aberration (SA), vertical coma (vcoma), horizontal coma (hcoma), higher order root mean square (hRMS) and total RMS] were evaluated before BTX-A treatment, 3 weeks after BTX-A treatment and 2 months after BTX-A treatment.
RESULTS: Six patients with BEB and 20 patients with HFS treated with BTX-A were evaluated in this study. Twenty contralateral spasm free eyes of 20 HFS patients were taken as control group. TMH and TMD were found to be significantly higher in eyes with spasm at both 3 weeks and 2 months after injection (TMH: 279.0 ± 123.2 at pretreatment, 380.5 ± 174.7 at third week and 317.0 ± 125.5 at second month p < 0.001 and p = 0.02, respectively), (TMD: 183.7 ± 59.7 at pretreatment, 235.7 ± 91.1 at third week and 209.8 ± 77.1 at second month p < 0.01 and p = 0.015, respectively). TBUT, CFSS, Schirmer I test values were similar (p > 0.05). OSDI scores decreased significantly from 29.6 ± 25.3 to 19.8 ± 20. p = 0.03 at third week and increased again by second month. K2 (43.9 ± 1.7 vs. 43.7 ± 1.6, p = 0.03) and astigmatism (0.8 ± 0.5 vs. 0.6 ± 0.4, p = 0.04) values were significantly lower at third week and increased again by second month. Pachymetry and aberrometric values did not change significantly. In the control group only Schirmer I test value decreased significantly at second month (10.5 ± 6.5 vs. 7.2 ± 5.6, p = 0.008), other parameters did not change.
CONCLUSIONS: BTX-A injection increases tear meniscus and decrease symptoms related to dry eye disease in BEB and HFS patients. It decrease astigmatism and keratometry values, it does not cause a significant change in corneal aberrations. However the positive effects of BTX-A injection on ocular surface is temporary.