title: Botulinum toxin uses in strabismus: A review of the injections performed during one year in a general hospital.
abstract: OBJECTIVE
  To analyse the indications, dosage and efficacy of botulinum toxin A injection performed in patients in a Strabismus Department.
  
  
  METHODS
  In this prospective study, botulinum toxin A was injected into 28 patients diagnosed with strabismus. Data was obtained from the records of patients that were evaluated during 2013 in the Strabismus Unit of Rey Juan Carlos Hospital (Móstoles, Madrid, Spain) in order to assess the indications and dosage of botulinum toxin A use in strabismus, as well as its clinical effect and differences in paediatric and adult patients. The outcomes in the last visit, at least 14 months after the injections, were analysed.
  
  
  RESULTS
  An analysis was performed on the data from 11 children, 6 females (54.5%), and 17 adults, 11 males (64%). The mean age was 4.42±3.48 years and 58.71±18.07 years in the children and adult groups, respectively. The majority of cases in both groups were esotropia (81.8% in children and 47.1% in adults). However the pathologies in the adult group were quite heterogeneous, including 4 patients with exotropia (26.5%), 4 with hypertropia (26.5%), and one with isolated nystagmus (5.9%). The mean number of the botulinum toxin injections in children was 1.45±0.93, although 72.7% received a single injection. In the adult group, the mean number of injections was 3.27±1.41. There was a statistically significant difference between pre- and post-injection in the tropia and phoria measurements in children and adults group (P<.05). In both groups there was a statistically significant improvement in post-injection torticollis when compared with the pre-injection measurement (P<.05). An improvement in the stereoacuity could be detected in 4 children. Two children (18.2%) and 5 adults (29.4%) required subsequent surgical intervention. Eight adult patients (49.1%) complained of diplopia in the primary position, which was resolved in 6 cases with toxin injection, whereas 2 needed surgery for diplopia correction.
  
  
  CONCLUSIONS
  Botulinum toxin is a very useful tool in the management of strabismus, obtaining better sensory and motor results in children, but it is also effective as a symptomatic treatment in some types of strabismus in adults.
authors.affiliation: Servicio de Oftalmología, Hospital Rey Juan Carlos, IISFJD, Móstoles (Madrid), España. Electronic address: elejarrin@hotmail.com.
authors.forename: E
authors.initials: E
authors.lastname: Jarrín
authors.affiliation: Servicio de Oftalmología, Hospital Rey Juan Carlos, IISFJD, Móstoles (Madrid), España.
authors.forename: E
authors.initials: E
authors.lastname: Arranz Márquez
authors.affiliation: Universidad Rey Juan Carlos, Móstoles (Madrid), España.
authors.forename: L
authors.initials: L
authors.lastname: Yebra González
authors.affiliation: Servicio de Oftalmología, Hospital Rey Juan Carlos, IISFJD, Móstoles (Madrid), España.
authors.forename: J
authors.initials: J
authors.lastname: García Gil de Bernabé
mesh_terms: D000328:Adult; D001905:Botulinum Toxins / Q000627:therapeutic use*; D019274:Botulinum Toxins, Type A; D002648:Child; D002675:Child, Preschool; D005260:Female; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D008297:Male; D009801:Oculomotor Muscles / Q000601:surgery; D011446:Prospective Studies; D013030:Spain; D013285:Strabismus / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A
keywords: Botulinum toxin; Diplopia; Endotropia; Esotropia; Estereopsis; Estrabismo; Stereoacuity; Strabismus; Torticollis; Tortícolis; Toxina botulínica