探讨在超声监测下注射A型肉毒毒素（BTXA)对甲状腺相关眼病（TAO）限制性斜视患者眼外肌厚度的改变以及改善斜视度的临床疗效观察。

选取2014年12月至2016年12月在北京协和医院眼科诊治的18例（21只眼）TAO限制性斜视患者，在非肌电图引导下注射BTXA，并应用超声分别在注射前、注射后1周、1个月、3个月进行眼外肌厚度的测量，并观察斜视度的改善情况。

所有患者眼外肌厚度在注射后均有不同程度下降，注射前后不同时间之间差异有统计学意义（F=26.72，P<0.01）。本研究中11只眼处于活动期，在注射治疗后1周、1个月、3个月的眼外肌厚度均小于注射前，差异有统计学意义（t=5.31、7.24、11.60，P均<0.05），10只眼为静止期，在注射后1周的眼外肌厚度大于注射前（t=-3.02，P<0.05），而注射后1个月、3个月的眼外肌厚度与注射前比较，差异无统计学意义。本研究21只眼中水平斜视7只眼，注射后1个月、3个月的平均斜视度均低于注射前，差异有统计学意义（t=3.60、4.05，P均<0.05）；注射后1周的平均斜视度与注射前差异无统计学意义。垂直斜视14只眼，注射后1周、1个月、3个月的斜视度均低于注射前，差异有统计学意义（t=2.39、3.89、4.87，P均<0.05）。2组斜视度均达到有效改善。活动期眼外肌厚度与斜视度无显著相关性（r=0.048，P=0.758），而静止期眼外肌厚度与斜视度有中等程度的相关性（r=0.421，P=0.007）。

超声为TAO限制性斜视的治疗提供了方便的监测方法。注射BTXA使TAO患者限制性斜视的眼外肌厚度明显下降，斜视度得到有效改善。

To investigate the clinical effect of botulinum toxin type A (BTXA) injection on the thickness of the extraocular muscles and the improvement of strabismus in patients with restrictive strabismus of thyroid associated ophthalmopathy (TAO) under ultrasonic monitoring.

From December 2014 to December 2016, 18 patients (21 eyes) with TAO restricted strabismus were injected with BTXA under the guidance of non-electromyography. The thickness of extraocular muscles was measured before injection, 1 week, 1 month and 3 months after injection with ultrasound, and the improvement of strabismus degree was observed.

The thickness of extraocular muscles in all patients decreased after injection. The difference was statistically significant in different time before and after injection (F=26.72, P<0.01). The 11 eyes in this group were in the active stage. The thickness of the extraocular muscles was less than that before the injection, 1week, 1 month and 3 months after injection. The difference was statistically significant (t=5.31, 7.24, 11.60, all P<0.05) and 10 eyes at inactive stage. The thickness of extraocular muscle at 1 week after injection was higher than that before injection (t=-3.02, P<0.05). The thickness of extraocular muscles at 1 and 3 months after injection was not significantly different from that before injection. The average strabismus degree in 1 month and 3 months after injection was lower than that before injection in 21 eyes, and the difference was statistically significant (t=3.60, 4.05, both P<0.05). The mean strabismus at 1 weeks after injection was not significantly different from that before injection. In the 14 eyes with vertical strabismus, the degree of strabismus at 1 week, 1 month and 3 months after injection were all lower than those before injection, and the difference was statistically significant (t=2.39, 3.89, 4.87, all P<0.05). The two groups of strabismus were all improved effectively. There was no significant correlation between the thickness of the extraocular muscles and the strabismus during the active stage (r=0.048, P=0.758), There was a moderate correlation between the thickness of extraocular muscles and strabismus at rest (r=0.421, P=0.007).

Ultrasound provides a convenient monitoring method for the treatment of TAO restrictive strabismus. Injection of BTXA reduced the thickness of extraocular muscles in TAO patients with restrictive strabismus, and improved the strabismus.