Botulinum toxin for treatment of restrictive strabismus / Botox y estrabismo restrictivo

Purpose: To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin. Methods: We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia. Results: We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3 ± 1.8 years. Conclusion: Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up (AU)

Objetivo: Estudiar los tipos de estrabismo restrictivo adquirido tratados en un hospital terciario, y los resultados del tratamiento utilizando toxina botulínica. Métodos: Realizamos un estudio retrospectivo de diez años en pacientes con estrabismo restrictivo y edades ≥18 años, a quienes se trató con toxina botulínica. El tratamiento se consideró exitoso cuando la desviación vertical final fue ≤5 PD, la desviación horizontal ≤10 PD, y no se produjo torsión ni diplopía. Resultados: Incluimos 27 casos (edad media, 61,9 años). Se diagnosticó estrabismo horizontal en el 11,1% de los casos, vertical en el 51,9%, y mixto en el 37%. El estrabismo fue secundario a: cirugía de cataratas en 6 casos, miopía magna en 6, fracturas orbitales 5, cirugía de la retina en 5, oftalmopatía de Graves en 4, y reparación de lesiones conjuntivales en 1 caso. Se diagnosticó diplopía en todos los pacientes, y tortícolis en el 33,3%. La desviación inicial fue de 14 PD (rango, 2-40), el número medio de inyecciones por paciente fue de 1,6 (rango, 1-3), y la dosis media de 9,5 IU (rango, 2,5-22,5). Al final del seguimiento, se registró diplopía en el 59,3% de los casos, tortícolis en el 18,5%, tratamiento quirúrgico en el 51,9%, y necesidad de gafas prismadas en el 14,8%. El resultado fue exitoso en el 37% de los pacientes (4 miopes magnos, 3 fracturas orbitaria, 2 post-cirugía de desprendimiento de retina, y 1 post-cirugía de cataratas). El seguimiento medio fue de 3 ± 1,8 años. Conclusión: Se observó desviación vertical en la mitad de la muestra. La desviación más frecuente fue secundaria a la cirugía de cataratas y a miopía magna. El tratamiento con toxina botulínica fue exitoso en una tercera parte de los pacientes al finalizar el seguimiento (AU)

Botulinum toxin for treatment of restrictive strabismus.

PURPOSE: To study the types of acquired restrictive strabismus treated in a tertiary hospital and the outcome of treatment with botulinum toxin. METHODS: We performed a 10-year retrospective study of patients with restrictive strabismus aged ≥18 years who were treated with botulinum toxin. Treatment was considered successful if the final vertical deviation was ≤5 PD, horizontal deviation ≤10 PD, with no head turn or diplopia. RESULTS: We included 27 cases (mean age, 61.9 years). Horizontal strabismus was diagnosed in 11.1%, vertical in 51.9%, and mixed in 37%. Strabismus was secondary to cataract surgery in 6 cases, high myopia in 6, orbital fractures in 5, retinal surgery in 5, Graves ophthalmopathy in 4, and repair of conjunctival injury in 1 case. Diplopia was diagnosed in all patients, head turn in 33.3%. The initial deviation was 14 PD (range, 2-40), the mean number of injections per patient was 1.6 (range, 1-3), and the mean dose was 9.5 IU (range, 2.5-22.5). At the end of follow-up, diplopia was recorded in 59.3%, head turn in 18.5%, surgical treatment in 51.9%, and need for prism glasses in 14.8%. Outcome was successful in 37% of patients (4 high myopia, 3 orbital fractures, 2 post-surgical retinal detachment, and 1 post-cataract surgery). Mean follow-up was 3±1.8 years. CONCLUSION: Vertical deviation was observed in half of the sample. The most frequent deviation was secondary to cataract surgery and high myopia. Treatment with botulinum toxin was successful in one-third of the patients at the end of follow-up.