探讨急性共同性内斜视(AACE)患者A型肉毒毒素治疗前后生存质量变化及其影响因素。

纳入2022年1月至2024年3月于首都医科大学附属北京同仁医院进行肉毒素注射的AACE患者39例(78只眼)。其中，男性19例(38只眼)，女性20例(40只眼)，年龄8~56岁，平均年龄(23.7±13.1)岁。所有患者分别于术前、术后1个月、术后3个月及术后6个月完成斜视度检查、双眼视觉功能检查以及患者生存质量评分(ASQE)。患者的年龄、斜视度、近立体视锐度及生存质量评分以±s描述，性别、双眼同时视功能、融合功能以及远立体视觉功能以例数和百分比描述。采用广义估计方程比较不同时间点患者的生存质量得分、斜视度及双眼视觉功能，组间比较采用Bonferroni法校正检验水准。采用单因素和多因素线性回归分析影响患者生存质量改善的相关因素。

术前、术后1个月、术后3个月及术后6个月患者ASQE总评分分别为(62.92±1.51)分、(83.47±1.99)分、(82.61±2.52)分及(83.31±2.54)分；各时间担忧较好视力眼维度评分分别为(66.26±5.64)分、(96.68±2.50)分、(88.76±3.59)分及(92.71±3.66)分；各时间距离评估维度评分分别为(72.78±1.92)分、(90.14±1.80)分、(90.19±1.83)分及(88.91±1.95)分；各时间视力定向障碍维度评分分别为(70.69±4.24)分、(86.71±3.34)分、(85.90±3.68)分及(89.63±2.99)分；各时间复视维度评分分别为(43.60±2.01)分、(72.59±3.32)分、(68.61±3.29)分及(68.97±3.76)分；各时间社会交往与外在表征维度评分分别为(55.87±3.53)分、(71.28±3.37)分、(75.47±3.70)分及(77.74±3.85)分。术后各时间点总评分及五项维度评分均较术前显著改善，差异有统计学意义(Wald χ² ＝66.83，24.58，51.74，15.71，66.33，25.18；P<0.05)。术前及术后各随访时间患者视远斜视度分别为(21.46±0.98)^△、(0.32±0.67)^△、(3.76±0.76)^△及(4.78±1.08)^△，术后各时间点均较术前显著降低，差异有统计学意义(Wald χ²＝202.21，P<0.05)。术前及术后各随访时间患者视近斜视度分别为(19.68±1.06)^△、(-0.09±0.54)^△、(2.56±0.74)^△及(3.57±1.03)^△，术后各时间点均较术前显著降低，差异有统计学意义(Wald χ²＝188.61，P<0.05)。术前、术后1个月、术后3个月及术后6个月患者远立体视觉存在率分别为58.97%、89.74%、89.74%及89.74%，术后各时间点均较术前有显著提升，差异有统计学意义(Wald χ²＝15.57，P<0.05)。术前、术后1个月、术后3个月及术后6个月患者近立体视锐度分别为(2.58±0.04)log弧秒、(2.02±0.06)log弧秒、(2.05±0.07)log弧秒及(2.06±0.07)log弧秒，术后各时间点均较术前显著改善，差异有统计学意义(Wald χ²＝44.27，P<0.05)。AACE患者生存质量评分改善程度与基线生存质量评分、末次随访斜视度、末次随访近立体视锐度及性别相关且有统计学意义(t＝-6.32，-3.90，-2.10，-2.52；P<0.05)。

AACE患者肉毒素治疗后斜视度、立体视觉功能及生存质量评分均有显著改善，女性、基线生存质量评分高、末次随访斜视度大及近立体视功能差是影响患者生存质量改善的独立危险因素。

The aim of this study is to investigate the changes of quality of life in patients with acute acquired comitant esotropia (AACE) before and after injection of botulinum toxin type A, and to analyze the related influencing factors.

A total of 39 patients (78 eyes) with AACE who received botulinum toxin type A injection at Beijing Tongren Hospital, Capital Medical University from January 2022 to March 2024 were enrolled, including 19 males (38 eyes) and 20 females (40 eyes) with a mean age of (23.67±13.06) years (ranging from 8 to 56 years). All patients underwent strabismus degree examination, binocular visual function examination, and completed the Amblyopia and Strabismus Quality of Life Evaluation (ASQE) questionnaire before treatment, as well as at 1, 3 and 6 months after injection. Age, strabismus degree and quality of life scores were described as ±s; gender, binocular simultaneous vision, fusion function and distant stereoscopic vision were described by case number and percentage. Generalized estimating equation was used to compare the quality of life scores, strabismus degree and binocular visual function at different time points, and Bonferroni method was adopted for post-hoc pairwise comparison. Univariate and multivariate linear regression analyses were performed to explore the influencing factors for the improvement of patients′ quality of life.

The total ASQE scores of patients were 62.92±1.51, 83.47±1.99, 82.61±2.52 and 83.31±2.54 at preoperative time, 1 month, 3 months, and 6 months postoperatively, respectively. The scores for the dimension of concern regarding the better-seeing eye at each time point were 66.26±5.64, 96.68±2.50, 88.76±3.59 and 92.71±3.66, respectively. The scores for the distance estimation dimension were 72.78±1.92, 90.14±1.80, 90.19±1.83, and 88.91±1.95, respectively. The scores for the visual disorientation dimension were 70.69±4.24, 86.71±3.34, 85.90±3.68, and 89.63±2.99, respectively. The scores for the diplopia dimension were 43.60±2.01, 72.59±3.32, 68.61±3.29, and 68.97±3.76, respectively. The scores for the social interaction and external appearance dimension were 55.87±3.53, 71.28±3.37, 75.47±3.70, and 77.74±3.85, respectively. There were significant improvements in the total and all five dimensional scores at all postoperative time points compared with the preoperative baseline (Wald χ² = 66.83, 24.58, 51.74, 15.71, 66.33, 25.18; P<0.05). The distance strabismus angles were (21.46±0.98)^△, (0.32±0.67)^△, (3.76±0.76)^△ and (4.78±1.08)^△ at each time point, respectively. The distance strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 202.21, P<0.05). The near strabismus angles were (19.68±1.06)^△, (-0.09±0.54)^△, (2.56±0.74)^△ and (3.57±1.03)^△ at each time point, respectively. The near strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 188.61, P<0.05). The prevalence of distant stereopsis was 58.97%, 89.74%, 89.74% and 89.74% at each time point, respectively. The prevalence was significantly elevated at all postoperative time points compared with baseline (Wald χ² = 15.57, P<0.05). The near stereoacuity was (2.58±0.04)log″, (2.02±0.06)log″, (2.05±0.07)log″ and (2.06±0.07)log″ at each time point, respectively. Near stereoacuity was significantly improved at all postoperative time points compared with baseline (Wald χ² = 44.27, P<0.05). The improvement degree of quality of life was significantly correlated with lower baseline quality of life score (t=-6.32, P<0.05), lower strabismus degree at the final follow-up (t=-3.90, P<0.05), and better near stereoacuity at the final follow-up (t=-2.10, P<0.05). In addition, the improvement of quality of life in female patients was significantly lower than that in males (t=-2.52, P<0.05).

For patients with AACE, botulinum toxin type A injection can significantly reduce strabismus degree, improve stereoscopic visual function and quality of life. Female gender, higher baseline quality of life score, larger strabismus degree and poorer near stereoscopic visual function at final follow-up are independent risk factors for unsatisfactory improvement of quality of life.