Комбинированное лечение тяжелой амблиопии, сочетанной с несодружественной эзотропией (клинический случай)

Abstract

Purpose - to evaluate the effectiveness of a joint method for the treatment of severe amblyopia, combined with uncomfortable esotropia, including chemodenervation of the extraocular muscle and subsequent pleoptic treatment using the «Ambliokor» medical complex. Material and methods. The patient is 3 years old. Diagnosis: unfriendly non-paralytic esohypertropia with a prevalence of OD; amblyopia, severe OD, moderate OS, mixed astigmatism OU. The treatment was carried out in 2 stages. At the first stage in order to eliminate the dysbinocular factor of amblyopia, chemodenervation of the internal rectus muscle of the right eye with the preparation of botulinum toxin type A «Botox» was performed by the intraoperative technique. After 1 month, at the second stage, a complex pleoptic treatment was carried out. Results. After chemodenervation, 1 month later, orthotropy in the primary gaze position without glasses and with glasses was achieved. The vertical deviation significantly decreased to 5 degrees in the position of adduction of the eyeballs. The right lead was restored fully. The forced turn of the head was eliminated. After the third course of complex pleoptic treatment, visual acuity with correction was 0.7 on the right and 0.8 on the left. Restoration of central visual fixation in the right eye was noted. The simultaneous nature of vision was revealed. The deviation angle of the eyes in the primary gaze position without glasses and with glasses to the nose did not exceed +7 degrees according to Hirshberg. Hypertropia persisted in adduction up to 10 degrees according to Hirschberg (hyperfunction of the inferior oblique muscle) in both eyes. «V»-syndrome persisted. The patient is planned to surgically weaken the hyperfunction of the inferior oblique muscle of both eyes, followed by the continuation of a complex of pleopto-orthoptic treatment. Conclusion. The existing extensive base of various methods of influencing the functions of the amblyopic eye allows for successful treatment of even severe amblyopia. Key words: amblyopia, unfriendly esotropia, chemodenervation, pleoptic treatment.