title: Bupivacaine and botulinum toxin to treat comitant strabismus.
abstract: OBJECTIVE
  To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A.
  
  
  METHODS
  Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10-MHz ultrasonography (eyelid technique).
  
  
  RESULTS
  Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness.
  
  
  CONCLUSIONS
  In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxin A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.
authors: Pediatric Ophthalmology and Strabismus Service, Department of Ophthalmology, Federal University of São Paulo - UNIFESP - São Paulo (SP), Brazil. luhopker@gmail.com
authors: Luisa Moreira
authors: LM
authors: Hopker
authors: Priscila Fernandes
authors: PF
authors: Zaupa
authors: Acácio Alves de Souza
authors: AA
authors: Lima Filho
authors: Monica Fialho
authors: MF
authors: Cronemberger
authors: Marcia Keiko Uyeno
authors: MK
authors: Tabuse
authors: Célia Regina
authors: CR
authors: Nakanami
authors: Norma
authors: N
authors: Allemann
authors: Tomás Scalamandré
authors: TS
authors: Mendonça
mesh_terms: D000293:Adolescent; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D005133:Eye Movements / Q000187:drug effects*; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D009801:Oculomotor Muscles / Q000187:drug effects*; D011446:Prospective Studies; D013285:Strabismus / Q000188:drug therapy*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000779:Anesthetics, Local; D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; D002045:Bupivacaine