Relief of periorbital pain after acute angle closure glaucoma attack by botulinum toxin type A.
OBJECTIVE
To assess the efficacy and safety of botulinum toxin type A (BoNT-A) injection in patients suffering from intractable periorbital pain after acute angle closure glaucoma (AACG).


METHODS
In this prospective randomized intervention study, 19 patients suffering from periorbital pain after an AACG attack were injected with BoNT-A or placebo for pain relief. Patients were assessed on days 1, 2, 7, 14, 30, 60, and 90. The main outcomes were mean change of visual analog rating scale (VARS) and index scores measured through a quality-of-life questionnaire (EQ-5D), and changes in the visual analog scale (VAS), all of which were assessed at each visit. A secondary outcome was the frequency and nature of adverse events and the number of patients who withdrew from the study as a result.


RESULTS
In the treatment group (n=10), the mean index score of EQ-5D and VAS changed significantly from the placebo group (by 0.299 and 2.61, respectively) from day 2 (P<0.01). The VARS of EQ-5D also disclosed significant changes from day 2 (17, P<0.01). In addition, efficacy was maintained mainly between days 2 and 60 but declined slightly by day 90. The most frequently reported treatment-related adverse events in the treatment and placebo groups were local tenderness (21%), subcutaneous hemorrhage (10.5%), and conjunctivitis (10.5%). No severe adverse events were reported during the study or follow-up period.


CONCLUSIONS
BoNT-A is effective and well tolerated for the treatment of periorbital pain after an AACG attack. Its effects may be maintained for 3 months.
Chien
Ke-Hung
KH
Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Lu
Da-Wen
DW
Chen
Yi-Hao
YH
Cheng
Jen-Hao
JH
Chen
Jiann-Torng
JT
D000208:Acute Disease; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D019274:Botulinum Toxins, Type A / Q000009:adverse effects / Q000627:therapeutic use*; D058447:Eye Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D005260:Female; D015812:Glaucoma, Angle-Closure / Q000150:complications* / Q000628:therapy; D006068:Gonioscopy; D006801:Humans; D007429:Intraocular Pressure; D032801:Iridectomy; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000009:adverse effects / Q000627:therapeutic use*; D009916:Orbital Diseases / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010148:Intractable Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010166:Palliative Care; D011446:Prospective Studies; D014065:Tonometry, Ocular
D000959:Antihypertensive Agents; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A