Journal of Otolaryngology and Ophthalmology of Shandong University ›› 2019, Vol. 33 ›› Issue (2): 119-122.doi: 10.6040/j.issn.1673-3770.0.2018.547

Previous Articles    

Clinical analysis of botulinum toxin type A microinjection in the treatment of acute acquired concomitant esotropia

YUE Pengcheng1, WANG Yuan2, WAN Xiaomei2, GONG Huaqing2   

  1. Shandong Institute of Ophthalmology, Qingdao Eye Hospital, Qingdao 266071, Shandong, China
  • Published:2019-03-28

Abstract: Objective To investigate the clinical efficacy of microinjection of botulinum toxin type A(BTX-A)into extraocular muscles through a microsurgical microincision of the bulbar conjunctiva in the treatment of acute acquired concomitant esotropia(AACE). Methods A retrospective analysis of continuous cases was performed. The data of AACE patients treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018 were reviewed. Routine examination was conducted, and the eye position, eye movement, and diplopia before injection were recorded. BTX-A injection was administered under a surgical microscope through a small conjunctival incision of 1-2 mm at the adhesion of the internal rectus muscle to expose its distal end. Routine ophthalmic examination was performed, and eye position, eye movement, and diplopia were examined 1 week, 1 month, and 3 months after the injection. Results A total of 28 AACE patients(30 eyes)were treated with BTX-A microinjection in Qingdao Eye Hospital between March 2017 and July 2018. The average strabismus before treatment was 33.2±15.6(+15~+60). The mean strabismus at 1 week, 1 month, and 3 months of treatment decreased to 9.8±7.2 (P< 0.001), 7.8±3.4(P<0.001), 9.3±5.2(P<0.001), respectively. There were no statistically significant differences in strabismus between the patients who were re-examined 1 week, 1 month, and 3 months after the surgery (P>0.05). Postoperative review after 1 week, 6.7%(2/30)of the injection eye eyelid ptosis slightly, 6.7%(2/30)of the injected eye < 10 training vertical strabismus, 3m re-examination of the above symptoms have disappeared. Three months after the injection, the symptoms of diplopia disappeared in 78.6%(22/28)patients, decreased in 7.2%(2/28)patients, and showed no significant change in 14.2%(4/28)patients. Conclusion BTX-A microinjection for AACE is safe, has a low incidence of complications, is effective, and is an ideal choice for the injection of extraocular muscles without EMG guidance.

Key words: Type A botulinum toxin, Acute acquired concomitant esotropia, Microsurgery

CLC Number: 

  • R777.4+1
[1] Scott AB. Botulinum toxin injection into extraocular muscles as an alternative to strabismus surgery[J]. J Pediatr Ophthalmol Strabismus,1980,17(1):21-25.
[2] 李凤鸣.中华眼科学[M]. 2版. 北京:人民卫生出版社,2006:2721-2272.
[3] 温晏, 万鲁芹, 万晓梅, 等. 眼表微创法注射A型肉毒毒素治疗斜视[J]. 眼科新进展, 2012, 32(4): 379-381. WEN Yan, WAN Luqin, WAN Xiaomei, et al. Minimally invasive injection of botulinum toxin type A from ocular surface for strabismus[J]. Recent Advances in Ophthalmology, 2012, 32(4): 379-381.
[4] Marsh IB, Botulinum Toxin In Ophthalmology Is Us-ed To Reduce The Function Of The Eyelid Muscles In Spasms Or Therapeutically. [J]. Hosp Med,2003,64(8):464-467.
[5] Etezad Razavi M, Sharifi M, Armanfar F. Efficacy of botulinum toxin in the treatment of intermittent exotropia[J]. Strabismus, 2014, 22(4): 176-181. doi: 10.3109/09273972.2014.962750.
[6] Ameri A, Mirmohammadsadeghi A, Makateb A, et al. Clinical outcomes of botulinum toxin injection in patients with cerebral palsy and esotropia[J]. Strabismus, 2015, 23(1): 8-13. doi: 10.3109/09273972.2014.999798.
[7] de Alba Campomanes AG, Binenbaum G, Campomanes Eguiarte G. Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia[J]. J AAPOS, 2010, 14(2): 111-116. doi: 10.1016/j.jaapos.2009.12.162.
[8] Jones A, Jain S. Botulinum toxin: a novel treatment for pediatric cyclic esotropia[J]. J AAPOS, 2014, 18(6): 614-615. doi: 10.1016/j.jaapos.2014.07.155.
[9] Tejedor J, Díez L. Temporary management of diplopia with botulinum toxin in multiple ocular motor cranial neuropathies[J]. Eur J Ophthalmol, 2012, 22(6): 1042-1044. doi: 10.5301/ejo.5000202.
[10] 吴晓. A型肉毒杆菌毒素治疗斜视的远期疗效观察[J]. 中国斜视与小儿眼科杂志, 1996, 4(3): 100-103. WU Xiao. A long-term therapeutic effect of botulinum toxin A for the treatment of strabismus[J]. Chinese Journal of Strabismus & Pediatric Ophthalmology, 1996, 4(3): 100-103.
[11] McNeer KW, Tucker MG, Spencer RF. Management of essential infantile esotropia with botulinum toxin A: review and recommendations[J]. J Pediatr Ophthalmol Strabismus, 2000, 37(2): 63-67; quiz 101-2.
[12] Campos EC, Schiavi C, Bellusci C. Critical age of botulinum toxin treatment in e-ssential infantile esotropia.[J]. J Pediatr Ophthalmol Strabismus, 2000,37(6): 328-32,354-355.
[13] 任美玉, 王琪, 王利华, 等. 急性获得性共同性内斜视的临床特征及手术疗效[J]. 中华眼科杂志, 2017, 53(12): 908-916. doi:10.3760/cma.j.issn.0412-4081.2017.12.006. REN Meiyu, WANG Qi, WANG Lihua, et al. Clinical features and surgical outcomes of acute acquired comitant esotropia[J]. Chinese Journal of Ophthalmology, 2017, 53(12): 908-916. doi: 10.3760/cma.j.issn.0412-4081.2017.12.006.
[14] 何丽, 马鲁新, 赵博军, 等. 急性共同性内斜视的临床特点、治疗方法及长期疗效[J]. 山东大学耳鼻喉眼学报, 2018, 32(3): 89-90, 95. doi: 10.6040/j.issn.1673-3770.0.2017.544. HE Li, MA Luxin, ZHAO Bojun, et al. Clinical characteristics of acute concomitant esotropia: long-term effects of curative treatment approaches[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(3): 89-90,95. doi: 10.6040/j.issn.1673-3770.0.2017.544.
[15] Wan MJ, Mantagos IS, Shah AS, et al. Comparison of botulinum toxin with surgery for the treatment of acute-onset comitant esotropia in children[J]. Am J Ophthalmol, 2017, 176: 33-39. doi: 10.1016/j.ajo.2016.12.024.
[16] Chen J, Deng D, Zhong H, et al. Botulinum toxin injections combined with or without sodium hyaluronate in the absence of electromyography for the treatment of infantile esotropia: a pilot study[J]. Eye(Lond), 2013, 27(3): 382-386. doi: 10.1038/eye.2012.264.
[1] Ming LIU. Treatment of epiglottic carcinoma by transoral laser microsurgery [J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018, 32(6): 4-7.
[2] MA Zhao-xin1, LI Ming2, CAO Yi2, CHEN Xu-hui2 . Surgery by a retrosigmoid keyhole approach in treatment of trigeminalneuralgia,  hemifacial spasm  and glossopharyngeal neuralgia [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2011, 25(5): 23-.
[3] YIN Guo-hua,ZHONG Xiao . Septorhinoplasty with reservation of the cartilage [J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2007, 21(4): 329-331 .
Full text



No Suggested Reading articles found!