A Study of the Effect of Botulinum Toxin A(Oculinum(R)) in the Case of Abducens Nerve Palsy

Seventeen cases of paralytic strabismus secondary to abducens nerve palsy were treated with an injection of Botulinum Toxin A(Oculinum(R)) into the medial rectus muscle under the electromyographic control. All 17 cases, including 3 cases of bilateral abducens palsy, were followed up for 6 months to 23 months after the initial injection, there were no systemic side effects. The etiologic factors follow up deviation angle, dosage and complications were analyzed In the Thirteen cases of Oculinum(R) injection in antagonistic medial rectus muscle, the mean correction of preinjection deviation was 48.7%; the four cases who underwent both Jensen's operation and Oculinum(R) injection obtained 64.6%. The most common complication was ptosis which developed in 15 cases(64.7%) with a dosage of 2.75 u or above. From this study. we concluded that Oculinum(R) chemodenervation was effective in the acute case of abducens palsy without the anterior segment ischemia and systemic side effects.

A Study of Non-surgical Treatment of Strabismus with Botulinum Toxin A(Oculinum(R))

Forty eight cases of strabismus were treated with an injection of Botulinum toxin A(Oculinum(R)) into the extraocular muscle under electromyographic control. There were 18 cases of esotropia, 14 of exotropia, 2 of hypertropia, 13 of unila teral abducens nerve palsy and 1 eyeball deviation even after the removal of old intraorbital metalic foreign body. All of the patients were followed up at least 6 months after the injection. By the final visit, the mean correction of preinjection deviation was 52.7% in esotropia, and 56.8% in exotropia, but there was no statistical significance between the two groups. Two patients of hypertropia obtained poor alignment chan ges after the injection. Among 13 patients with sixth nerve palsy, 10 who received injection only obtained mean 53.2% of correction and 3 patients who underwent both the injection and Jensen operation obtained 71.6%. In the one case of old intraorbital foreign body, lateral and inferior deviation before the injection were 60 P.D. and 20 P.D. respectively. After 5 months of injection, it improved to orthophoria and diplopia disappeared at primary position. The most common complication was ptosis, and it occurred in 19 patients(39.5%). Induced vertical deviation had the longest mean duration, lasting for 71.1 dyas. Twelve of 48 patients did not show any complications. No systemic complications were observed in any of the patients.