Long-term results of botulinum toxin in consecutive and secondary exotropia: outcome in patients initially treated with botulinum toxin.

INTRODUCTION: Long-term ocular alignment can be difficult to achieve in patients with consecutive and secondary (sensory) exotropia, and botulinum neurotoxin A (BTXA) is a recognized alternative to surgery in this group. PATIENTS AND METHODS: We reviewed the results of 44 patients aged 15 to 77 years (mean 31 years) who underwent their first BTXA injections from 1989 to 1990. In 30% of cases the choice of toxin treatment was made by the patient. In the remainder BTXA was recommended by the clinician to assess the risk of postoperative diplopia. Thirty-three patients (75%) were consecutively exotropic and 68% of patients had had previous strabismus surgery. The mean preinjection deviation was 41 delta of exotropia (range 12 to 85 delta exotropia) and the minimum mean angle change after 1 injection was 27 delta (range 0 to 57 delta). The average number of injections was 3 (range 1 to 17). RESULTS: Of the patient group, 59% went on to strabismus surgery, 14% continued to attend for maintenance treatment, and 9% were discharged with a small, stable deviation. The remainder were either followed up elsewhere or failed to reattend. CONCLUSIONS: Botulinum toxin appears to be a satisfactory treatment for constant exotropia in patients at risk of postoperative diplopia who have undergone multiple operations but, because more than half the group went on to surgery, surgery as a first therapy may be preferable in uncomplicated cases.     

Tear production and drainage after botulinum toxin A injection in patients with essential blepharospasm

Purpose: To evaluate the clinical manifestations of tear production, distribution and drainage in the essential blepharospasm patients, and to analyse the changes after botulinum toxin A injection in these patients. Methods: This prospective study was performed in 23 patients with essential blepharospasm treated with Botulinum neurotoxin A (BoNT‐A; Dysport, Ipsen Biopharm, UK) from November 2010 to February 2011. Ocular examinations, including frequency and severity of blepharospasm, tear break up time (BUT), Schirmer’s test, lower lid tear meniscus height (TMH) measured by optical coherence tomography (OCT, rtvue software version 3.5; Optovue Inc., Fremont, CA, USA), and dacryoscintigraphy using 99m technetium pertechnetate, were performed before and 2 weeks after BoNT‐A injection. We asked all patients about changes in the dry eye symptom score, before and after treatment. Results were analysed with independent t‐test using spss software version 12.0 for Windows XP, (SPSS Inc., Chicago, IL, USA). Results: Botulinum neurotoxin A treatment relieved blepharospasm in all patients. Mean injection dose was 38 ± 5.6 units. After injection, mean tear BUT was significantly increased from 4.7 ± 4.9 to 6.6 ± 1.6 seconds (p = 0.001) Lower TMH increased in all three points and most notably at the lateral point (p = 0.05). On dacryoscintigraphy, tear drainage velocity was not affected by BoNT‐A treatment. But Tc‐99m 50% clearance time in interpalpebral fissure significantly increased from 1564 to 2220 seconds on the time activity curve (p = 0.027). Subjective dry eye symptoms also improved in 16 patients (70%) after injection. Conclusion: Tear film stability and TMH increased, but tear drainage velocity was not affected by BoNT‐A treatment. Overall Tc‐99m 50% clearance time in interpalpebral fissure significantly increased, and tear storage from mild lateral lower eyelid laxity increased after BoNT‐A injection. Botulinum neurotoxin A injection was also effective for combined dry eye symptom in the essential blepharospasm patients.     

A型肉毒素治疗特发性眼睑痉挛后眼表改变

目的：通过比较A型肉毒素治疗特发性眼睑痉挛前后患者眼表指标的变化,探讨其对眼表稳定性的影响。方法：前瞻性研究。收集2017年1-6月就诊于延安大学附属医院眼科门诊欲行A型肉毒素注射治疗的特发性眼睑痉挛患者,分别于注射前、注射后2周采用Jankovic量表（JRS）对其病情进行评分;采用眼表疾病指数量表（OSDI）对其眼表症状进行评分;裂隙灯显微镜观察泪膜破裂时间（BUT）和角膜荧光素钠染色情况;Schirmer Ⅰ试验测定泪液分泌量。采用配对t检验和Spearman秩相关检验对所得数据进行分析。结果：共纳入特发性眼睑痉挛患者30例（60眼）,其中60%（18/30）合并干眼,且OSDI评分与JRS评分呈弱的正相关关系（r=0.278P=0.032）。所有患者经A型肉毒素注射后病情均有不同程度的缓解,JRS评分由5.5±1.0减少至0.6±1.0（t=25.730,P<0.001）。同时干眼患者中12例干眼症状也得到了缓解,OSDI评分由34.0±7.8下降为21.7±9.1（t=7.946,P<0.001）;BUT由（6.3±2.1）s增加至（8.0±2.0）s （t=4.389,P<0.001）;角膜荧光素钠染色评分也由1.0±1.0下降至0.6±0.7（t=2.963,P=0.004）,治疗前后比较差异均具有统计学意义。结论：A型肉毒素注射治疗有助于缓解特发性眼睑痉挛引起的干眼。     

Pain relief in patients receiving periocular botulinum toxin A

PURPOSE: We hypothesized that patients with benign essential blepharospasm and hemifacial spasm experience relief of headache and eye pain after botulinum toxin injections. METHODS: A retrospective chart review of 85 patients who had received botulinum toxin injections at the University of Minnesota for treatment of benign essential blepharospasm and hemifacial spasm was conducted. A prospective telephone questionnaire was used to ascertain details regarding improvement of headache and eye pain. RESULTS: Of the 85 patients (34 men, 51 women), 20 patients (23.5%) had headaches and 29 (34.1%) had eye pain. Ten of 20 (50.0%) headache-positive patients and 24 of 29 patients (82.8%) with eye pain had reduction in their pain after botulinum toxin injections. CONCLUSION: The findings of this study support the use of botulinum toxin for headache and eye pain relief in patients with benign essential blepharospasm and hemifacial pain. In addition, with the expanding uses of botulinum toxin, the results support its antinociceptive effects. Further investigation should continue in the mechanism of botulinum toxin's effects on pain.     

Management of strabismus with botulinum A toxin

Three hundred eight patients with strabismus were treated with botulinum A toxin (Oculinum) chemodenervation; 153 were followed by the authors for at least 6 months. In this study group, 97 received botulinum A toxin injections as the primary method of treatment of their ocular deviation. Fifty-six received injections after traditional extraocular muscle surgery. Botulinum A toxin was useful for management of patients with recent surgical overcorrections and for management of some patients with sixth cranial nerve palsy. Chemodenervation of an extraocular muscle was not as successful as traditional strabismus surgery for treatment of infantile esotropia and other comitant deviations. Botulinum A toxin injection was ineffective in patients who had restrictive strabismus. This drug has limited application in the management of patients with strabismus.     

Negative antibody response to long-term treatment of facial spasm with botulinum toxin

Over a period of 163 weeks, 223 injections of botulinum A toxin were administered to 38 patients with facial spasm syndromes. The maximum cumulative toxin dose was 553 units, the maximum number of injections in any given patient was 16, and the maximum dosage of any given injection was 52.5 units. Sera from these patients showed no antibody production when measured with a standard mouse lethality bioassay.     

肉毒毒素治疗特发性睑痉挛的临床疗效

目的 探讨局部注射A型肉毒杆菌毒素治疗特发性睑痉挛的疗效。方法 对35例特发性睑痉挛患者局部注射A型肉毒杆菌毒素。结果 35例患者均取得满意疗效，无全身反应，局部副作用轻微，短暂。可重复注射，无过敏反应。结论 A型肉毒杆菌毒素为一安全，有效，可靠的制剂，治疗方法简便易行，可作为治疗眼睑痉挛的首选药物。     

Treatment of acquired nystagmus with botulinum A toxin

We injected botulinum A toxin into the retrobulbar space of one eye each in two patients who had acquired nystagmus with oscillopsia and decreased vision. After injection of 25 units of botulinum A toxin, visual acuity improved from 20/80 to 20/30 in one patient, and both patients were able to read and watch television. Improved vision lasted from five to 13 weeks. No adverse side effects were observed after a total of five injections in each patient.     

A型肉毒杆菌毒素治疗麻痹性斜视

采用眼外肌注射A型肉毒杆菌毒素的方法,治疗17例(18只眼)麻痹性内斜视患者。最大的肌肉麻痹作用发生于注射后7～14天,最大斜视矫正度为50-,随访时间为4～20周,5例最终获得双眼视。未见全身副作用。认为,这种疗法可在部分患卉中替代斜视矫正术。     

Treatment of strabismus in adults with botulinum toxin A.

Eighty-five adults with horizontal concomitant strabismus were treated with an injection of a low dose of botulinum toxin A (BTXA) into the lateral or medial rectus muscle. The ocular deviation was reduced by an average of 60% independently of its size and whether or not surgery had previously been performed. The change was temporary, however, except in those cases with binocular functions, when fusion was re-established. Repeated low dose injections can maintain the improvement, but at higher doses, although larger reductions are produced, temporary local side effects--ptosis and vertical strabismus--are common. The technique is simple, well tolerated, and has no systemic side effects.     

Treatment of congenital esotropia with botulinum toxin type A

Purpose: To examine the effect of botulinum toxin type A injections given transconjunctivally into the medial recti muscles in patients with congenital esotropia. Methods: Eighty‐two patients with congenital esotropia were treated with botulinum toxin type A transconjunctival injections into the medial recti muscles. Results: A Kaplan–Meier curve shows a 24‐month success rate of 87% (n = 53) with alignment within 20 prism dioptres (PD) of the 80 patients who were seen at least 1 year following the last injection. Seven of the 80 patients underwent standard monocular surgery with recession of the medial rectus and resection of the lateral rectus muscle. Two patients were lost during follow‐up. Conclusion: Botulinum toxin type A injections into the medial recti muscles are a valuable alternative to conventional strabismus surgery.     

A型肉毒毒素治疗儿童共同性斜视

A型肉毒毒素（BTXA）的治疗原理为通过化学去神经作用暂时性地改变肌张力。它不影响肌肉的解剖位置以及远期的生理功能，并具有可逆、可重复、操作简单和副作用少等优点。经过20多年的临床研究和应用，BTXA治疗已成为安全有效的斜视手术的补充和替代疗法。它在治疗成人麻痹性斜视方面的作用已得到公认，但在治疗儿童斜视方面的疗效至今还存在异议。本文就数十年来各国学者对于BTXA治疗儿童共同性斜视的研究结果作一综述。     

Optic neuropathy associated with botulinum A toxin in thyroid-related orbitopathy

PURPOSE: To report the development of optic neuropathy after botulinum A toxin injection for restrictive myopathy from thyroid-related orbitopathy (TRO). METHODS: We retrospectively reviewed the records of three patients with TRO who underwent botulinum A toxin injection for restrictive myopathy and subsequently developed optic neuropathy. Development of optic neuropathy was measured by visual acuity, color vision testing, visual field testing, and relative afferent pupillary testing. RESULTS: At 3 week follow-up after botulinum A toxin injection, three patients were noted to have clinical signs and symptoms of optic neuropathy in the ipsilateral eye following injection of botulinum A toxin for restrictive myopathy. Treatment with oral steroids followed by orbital wall decompression reversed the optic neuropathy. CONCLUSIONS: To our knowledge, this is the first report of optic neuropathy associated with botulinum A toxin injection in TRO. Clinicians should be aware of this potential vision threatening complication.     

Treatment of blepharospasm with botulinum toxin

In 43 patients (81 eyes) with blepharospasm resistant to other forms of therapy, 149 outpatient injections of botulinum A toxin were given into the orbicularis oculi muscle. Subsequent follow-up periods ranged from ten to 210 days. Orbicularis oculi spasm, eyelid forced closure, and eyebrow spasm all decreased substantially over the first ten days following the initial injection. Patients with essential blepharospasm, hemifacial spasm, or previous surgery all responded in a similar fashion. This beneficial effect was transient, however, and additional treatment was required for sustained relief. Twenty-five patients received multiple injections with a mean interval of 65 days. Results of second and third injections were similar to the first in rapidity of onset and duration of effect. Complications were local, mild, and transient, and no systemic side effects were noted.