Comparing Botulinum Toxin Injections with Extraocular Muscle Surgery in Toddlers with Esotropia: A Retrospective Analysis

2021 ◽  
Vol 238 (04) ◽  
pp. 478-481
Author(s):  
Tristan Michael Handschin ◽  
Francoise Roulez ◽  
Andreas Schötzau ◽  
Anja Palmowski-Wolfe
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Dose Effect ◽  
Advantages And Disadvantages ◽  
Angle Of Deviation ◽  
Group 2 ◽  
Encrypted Database ◽  
Botulinum Toxin Injections ◽  
Extraocular Muscle Surgery

Abstract Background In toddlers with esotropia, early alignment of the visual axes either with extraocular muscle surgery (EOMS) or botulinum toxin injections (BTIs) into both medial rectus muscles may result in improved depth perception. We compared the outcome of BTIs with EOMS in toddlers in order to gain further insight into the advantages and disadvantages of either method. Patients and Methods In this retrospective study, our encrypted database was searched for toddlers with esotropia aged 35 months or younger at the time of initial treatment with either BTIs or EOMS and who had a follow-up of at least 2 years. We analyzed the angle of deviation, dose effect (DE), and binocularity as well as the number of interventions. Results We identified 26 toddlers who received their first treatment for esotropia within the first 35 months of life: 16 with BTIs (9 males, 7 females) and 10 with EOMS (3 males, 7 females). Mean follow-up was considerably longer in the EOMS (87.7 months) than in the BTI group (35.7 months). Age at first intervention was 22.8 months in the BTI and 24.1 months in the EOMS group, and each toddler wore its full cycloplegic refraction. Mean angle at treatment was 41.25 prism diopters (PD) in the BTI compared to 52.9 PD in the EOMS group. The BTI group received an average of 1.68 BTIs, with a mean dosage of 14.5 IU Botox and a mean DE (mDE) of 1.8 PD/IU. In the EOMS group, the average number of surgeries was 1.4, with a mean dosage of 16.85 mm and a mDE of 3.14 PD/mm surgery. Some degree of binocularity could be observed in 9 (56%) of the BTI (5 × Bagolini positive, 2 × 550″, 2 × 220″) and in 4 (40%) of the EOMS group (2 × 3600″, 1 × 550″, 1 × 300″). By the end of the BTI group follow-up, four toddlers electively underwent EOMS rather than a 3rd BTI (followed by a 3rd BTI in 1), which resulted in the appearance of measurable binocularity in all four (1 × Bagolini positive, 1 × 220″, 1 × 200″, 1 × 60″). Conclusions Our results show that BTIs are a viable treatment alternative in early esotropia. Even if EOMS is ultimately required, some binocularity may develop as the visual axes are aligned for some time in the sensitive phase owing to the effects of Botox. Moreover, less surgical dosage is needed than would have otherwise been necessary to treat the original angle of deviation. BTIs are faster, less invasive, and present as an effective alternative when patient compliance is too low to reliably measure the angle of deviation, which is essential for the planning of EOMS.

Persistent Diplopia in Visually Mature Patients. Is it Intractable or something else? A Review and Case Series

2017 ◽  
pp. 90-108
Keyword(s):  
Botulinum Toxin ◽  
Extraocular Muscle ◽  
Botulinum Toxin Injection ◽  
Case Series ◽  
Sensory Adaptation ◽  
Single Vision ◽  
Injection Treatment ◽  
Vision Therapy ◽  
Extraocular Muscle Surgery

Diplopia is described as being intractable when there is inability to both fuse the two images and suppress the second image. Intractable diplopia persists despite achieving ocular alignment using either prisms, lenses,vision therapy,extraocular muscle surgery, or botulinum toxin injection. Treatment usually resorts to occluding or fogging the patient’s nondominant eye. Often times, however, adults having other causative mechanisms for supposedly persistent diplopia are able to achieve comfortable single vision with treatment that either establishes fusion or reactivates a preexisting sensory adaptation. This case series reviews these other causes of diplopia.

Number of botulinum toxin injections needed to stop requests for treatment for chronic lateral epicondylar tendinopathy. A 1-year follow-up study

2019 ◽  
Vol 62 (5) ◽  
pp. 336-341 ◽  
Author(s):  
Mélanie Cogné ◽  
Alexandre Creuzé ◽  
Hervé Petit ◽  
Claire Delleci ◽  
Patrick Dehail ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Follow Up Study ◽  
Botulinum Toxin Injections

scholarly journals Botulinum Toxin Injection with Conjunctival Microincision for the Treatment of Acute Acquired Comitant Esotropia and Its Effectiveness

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Hongjia Xu ◽  
Weifeng Sun ◽  
Shuying Dai ◽  
Yanyan Cheng ◽  
Jing Zhao ◽  
...  
Keyword(s):  
Botulinum Toxin ◽  
Binocular Vision ◽  
Botulinum Toxin A ◽  
Botulinum Toxin Injection ◽  
Age At Onset ◽  
Brain Magnetic Resonance Imaging ◽  
Significant Difference ◽  
Angle Of Deviation ◽  
The Mean

Purpose. To report on an improved botulinum toxin injection with conjunctival microincision for beginners, and to determine the effectiveness of botulinum toxin A (BTXA) in the treatment of patients with acute acquired comitant esotropia (AACE). Methods. Medical records of 29 AACE patients were retrospectively analyzed. BTXA was injected into the unilateral or bilateral medial rectus muscle with conjunctival microincision without electromyographic guidance. Success was defined as total horizontal deviation ≤10 prism diopters (PD) and evidence of binocular vision. Results. Twenty-nine patients were included, of whom 22 were male and 7 were female. The mean age at onset was 14.2 ± 7.4 (range, 4–34) years. The mean time from onset of AACE to injection was 18.4 ± 20.3 (range, 1–96) weeks. All patients completed at least 6 months of follow-up, and the mean follow-up after BTXA injection was 12.3 ± 4.8 months (range, 7–24 months). Neurological evaluation and brain magnetic resonance imaging (MRI) were unremarkable in all patients. The mean spherical equivalent refraction was −1.22 ± 2.85D and −0.97 ± 2.80D in the right and left eyes, respectively. Mean preinjective esotropia was 38.4 ± 18.9 PD (range, +10–+80 PD) at near and 40.2 ± 17.7 PD (range, +20–+80 PD) at far distance. The mean angle of deviation at 6 months after injection was 0.6 ± 4.1 PD (range, −3–+15 PD) at near and 3.0 ± 5.9 PD (range, 0–+20 PD) at far distance. There was significant difference in the angle of deviation at near and far fixation between pre-BTXA and post-BTXA 6 months ( p < 0.001 , p < 0.001 , resp.). There was no significant difference in the angle of deviation at near and far fixation between post-BTXA 6 months and post-BTXA at final follow-up ( p  = 0.259 and 0.326, resp.). Mean stereoacuity improved from 338 to 88 arc seconds. During the follow-up period, 5 of 29 patients had recurrent esotropia. Two patients refused all further treatment, and the other 3 patients required incisional strabismus surgery. The success rates were 86.2% (25/29) at 6 months and 82.8% (24/29) at final follow-up. Conclusion. Conjunctival microincision injection of botulinum toxin is a practical and safe method for beginners to locate an extraocular muscle, which is as effective as the traditional methods. Botulinum toxin injection can be preferred as the first-line treatment for AACE patients with potential binocular vision.

scholarly journals Efficacy of Intralesional Injection of Botulinum Toxin in Treatment of Keloids

2021 ◽  
pp. 124-130
Author(s):  
Toka Ahmed El Sayed ◽  
Yomna Mazid Neinaa ◽  
Dareen Abd El-Aziz Mohamed ◽  
Nashwa Naeem El Far
Keyword(s):  
Wound Healing ◽  
Botulinum Toxin ◽  
Rating Scale ◽  
Intradermal Injection ◽  
Intralesional Injection ◽  
Efficacy And Safety ◽  
Interventional Study ◽  
Botulinum Toxin Injections ◽  
Positive Significant Correlation

Background: Keloid is generally accepted to be the result of prolonged and aberrant wound healing. Botulinum toxin injections are considered an efficient therapy for keloids. The current study evaluated the efficacy and safety of intralesional injection of botulinum toxin in treatment of keloids. Methods: This prospective interventional study was carried out on 20 patients presented with keloids. Patients were treated by intradermal injection at the periphery of lesions by botulinum toxin as 100 IU diluted by 2 ml normal saline (5 IU/ cm3). Vancouver Scar Scale (VSS) and Verbal Rating Scale (VRS) were used for the assessment of the therapeutic efficacy. Results: There was a statistically significant improvement in all VSS and VRS parameters. Vast majority, 18 (90%) patients, were satisfied and 2 (10%) patient was not satisfied. There was non-significant correlation between the age of patients, duration of keloid nor size of keloid in relation to degree of improvement of VSS after treatment. There was positive significant correlation between VSS before treatment and degree of improvement of VSS after treatment. Conclusions: Intralesional injection of botulinum toxin was effective and safe therapeutic techniques in inhibiting keloids regarding the statistically significant improvement on comparing between before treatment and after the end of follow up period.

Long Term Follow-up of Extraocular Muscle Surgery for Congenital Esotropia

1991 ◽  
Vol 41 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Anthony R. Caputo ◽  
Suqin Guo ◽  
Rudolph S. Wagner ◽  
Maria V. Picciano
Keyword(s):  
Extraocular Muscle ◽  
Long Term Follow Up ◽  
Congenital Esotropia ◽  
Extraocular Muscle Surgery

scholarly journals Clipping versus coiling in unruptured anterior cerebral circulation aneurysms

2020 ◽  
Vol 11 ◽  
pp. 50
Author(s):  
Farrag Mohammad ◽  
Takashi Horiguchi ◽  
Katsuhiro Mizutani ◽  
Kazunari Yoshida
Keyword(s):  
Cerebral Circulation ◽  
Unruptured Aneurysms ◽  
Advantages And Disadvantages ◽  
The Past ◽  
Unruptured Intracranial Aneurysms ◽  
Hospitalization Period ◽  
Ischemic Complications ◽  
Group 2 ◽  
Ischemic Events

Background: Unruptured intracranial aneurysms (UIAs) are not uncommon, especially in Japan. Treatment strategy for UIAs has evolved in the past decades in Western countries with the increased use of endovascular treatment as the primary option, but in Japan, clipping still has the upper hand. Methods: This study retrospectively included 200 patients treated by clipping or coiling for UIAs located in the anterior cerebral circulation. Postoperative angiographic and clinical outcomes were evaluated. Results: Of 200 UIAs, 147 and 53 were treated by surgery and coiling, respectively. The average follow-up duration was 30.2 ± 18.8 months for clipping and 29.3 ± 17.6 months for coiling. Complete occlusion was greater in the surgery group (78.9%) than the endovascular group (18.8%). Regrowth occurred in 1.4% of the clipping group and 13.2% of the coiling group. Ischemic events were encountered in both groups; asymptomatic ones were higher in the coiling group (24.5%) than in the clipping group (2%), while symptomatic ischemic complications were equal (7.5%) in both groups. The deterioration of modified Rankin scale was detected totally in 13 UIAs (6.5%) with no statistical difference between groups. Postoperative hospital period was longer in clipping (P = 0.01). Conclusion: Clipping and coiling were both safe and feasible in the treatment of unruptured aneurysms. The clipping was advantageous in durability, while the rate of morbidity was lower, and hospitalization period was shorter in the coiling group. The clipping and coiling should coexist while complementing each other by understanding the advantages and disadvantages of both.

A COMPARATIVE STUDY BETWEEN EFFICACIES OF USG GUIDED BOTULINUM TOXIN INJECTION INTO THE SUBSCAPULARIS MUSCLE AND THE CONSERVATIVE TREATMENT IN HEMIPLEGIC SHOULDER PAIN

2021 ◽  
pp. 16-20
Author(s):  
Subhadeep Batabyal ◽  
Saumen Kumar De ◽  
Rathindra Nath Haldar
Keyword(s):  
Botulinum Toxin ◽  
Conservative Treatment ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
External Rotation ◽  
Botulinum Toxin Injection ◽  
Subscapularis Muscle ◽  
Group 2 ◽  
Group 1

Introduction: Hemiplegic shoulder pain (HSP) is a common complication after stroke. HSP inhibits recovery and rehabilitation and impairs the quality of life of stroke survivors. Although the etiology of HSP is not well known, it has been suggested that multiple factors contribute to HSP. Our approach is to compare the efcacy of USG guided Botulinum toxin injection into the subscapularis muscle and conservative treatment in case of intractable hemiplegic shoulder pain. Material and methods: In this Parallel Group Open Level Randomized Controlled Trial, conducted in the Department of Physical Medicine and Rehabilitation, IPGME&R, SSKM Hospital, Kolkata between September, 2017 to September, 2018 (Twelve months) on 34 (17 in each group) patients with intractable (persistent pain for more than 3 months) hemiplegic shoulder pain. In group 1, Botulinum toxin injection was given in subscapularis muscle by USG guided lateral approach. In group 2, managed conservatively with Physical therapy (stretching, passive range of motion exercise), Modality (hot pack, infrared, IFT), pain medications (NSAIDS, oral opioids) and Neuromuscular electrical stimulation of shoulder. Parameters used: 1. Pain intensity - measured by Numerical Rating Scale (NRS) [Score 0- 10], 2. Spasticity measured by - Modied Ashworth Scale (MAS) [score 0-4], 3. Shoulder range of motion - External rotation (ER) [score 0- 90] assessed. The patients attending the Physical Medicine and Rehabilitation OPD at IPGME&R and SSKM Hospital, Kolkata were included and studied if they fullled the inclusion and nd exclusion criteria after getting Institutional Ethics Committee clearance and informed written consent. After initial visit, followed up on 2 week, th th 4 week and 12 week. Comparison done considering all the parameters considering basal and follow up data to compare the efcacy of intramuscular botulinum toxin injection and those with in group 2, managed conservatively. Results: All the data collected during this study period were analyzed by using statistical software Statistica vertsion 6 [Tulsa, Oklahoma: StatSoft Inc., 2001] and GraphPad Prism version 4 [San Diego, California: GraphPad Software Inc., 2005]. There was statistically signicant difference (group 1 is statistically superior than group 2) between two groups at 2nd, 4th and 12th week in respect to NRS, MAS of subscapularis and ER of shoulder joint (p value<0.05). Conclusion: There was signicant short-term improvement of shoulder pain, spasticity of shoulder internal rotator(subscapularis) and range of motion in the form of external rotation after Botulinum toxin injection compared to conservative treatment. But in terms of intermediate-term and long-term follow-up although both groups showed signicant improvement but Botulinum toxin injection group was statistically superior than conservative treatment.

Physiotherapy and Botulinum Toxin Injections Prior to Stabilization Surgery for Recurrent Atraumatic Anteroinferior Shoulder Dislocation with Abnormal Muscle Patterning

2012 ◽  
Vol 4 (4) ◽  
pp. 287-290 ◽  
Author(s):  
Clare P. Donnellan ◽  
Martin A. Scott ◽  
Mary Antoun ◽  
W. Angus Wallace
Keyword(s):  
Botulinum Toxin ◽  
Shoulder Instability ◽  
Shoulder Dislocation ◽  
Marked Improvement ◽  
Latissimus Dorsi ◽  
Shoulder Stabilization ◽  
Patient Reported ◽  
Teres Major ◽  
Botulinum Toxin Injections

Shoulder instability is a complex phenomenon and repeated dislocation due to persistent abnormal muscle patterning can be challenging to manage. This case report describes the treatment of a 21-year old female who presented with repeated atraumatic anteroinferior shoulder dislocation due to abnormal muscle patterning. Management involved physiotherapy to re-educate muscle control combined with botulinum toxin injections into pectoralis major, latissimus dorsi and teres major prior to shoulder stabilization surgery. The patient reported marked improvement as reflected by improved scores on the Oxford Shoulder Instability Score and Western Ontario Shoulder Instability Score. Benefits were maintained at 3 year follow-up.

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