[Preoperative prediction of the amount of surgical correction by using Botulinum A type toxin for the treatment of paralytic esotropia].
The aim of this study was to obtain the correct choice of initial surgical procedure and to predict the amount of surgical correction by using the maximum reduction rate of eye position after Botulinum A-type toxin injection for the treatment of acquired neurogenic paralytic strabismus. The subjects were 30 with sixth nerve palsy and 33 with non-paralytic esotopia with no previous surgery. The results were that if the maximum reduction rate of eye position after the first injection of 1.25 U was less than 68%, the modified Jensen procedure with recession of medial rectus muscle was necessary to achieve 100% recovery. However, if it was more than 100%, then recession-resection of the horizontal rectus muscles alone produced successful ocular alignment. Based on our data of 100 cases of sixth nerve palsy that showed spontaneous recovery, we conclude that surgical treatment should be planned, if the maximum percentage reduction of preoperative eye position after Botulinum A-type toxin treatment is under 68% (reflecting the inability of the medial rectus muscle to contract and the lengthening of the lateral rectus muscle), and if the patient has no spontaneous improvement at all within 12 weeks after onset.
Iwashige
H
H
Department of Ophthalmology, Teikyo University School of Medicine, Tokyo, Japan.
Takahashi
H
H
Nakamura
K
K
Nemoto
Y
Y
Ishida
T
T
Maruo
T
T
D000010:Abducens Nerve; D000293:Adolescent; D000328:Adult; D000368:Aged; D001905:Botulinum Toxins / Q000627:therapeutic use*; D003389:Cranial Nerve Diseases / Q000150:complications; D004948:Esotropia / Q000209:etiology / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010243:Paralysis / Q000150:complications*; D011237:Predictive Value of Tests; D011300:Preoperative Care
D001905:Botulinum Toxins