Botulinum toxin a as an intraoperative adjunct to horizontal strabismus surgery

Abstract

In their case series of Botulinum Toxin A (Botox®; Allergan, Irvine, CA) as an intraoperative adjunct to strabismus surgery, Özkan et al 1 Özkan S.B. Topaloglu A. Aydin S. The role of botulinum toxin A in the augmentation of the effect of recession and/or resection surgery. J AAPOS. 2006; 10: 124-127 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar found the technique of injection of the recessed muscle in a recession-resection procedure effective for both large-angle comitant esotropia and exotropia. However, in my clinical experience, the procedure works best when bilateral medial rectus recessions and injections are performed in the setting of large-angle comitant esotropia (>70Δ). 2 Khan A.O. Two muscle horizontal rectus surgery combined with botulinum toxin in the treatment of very large angle esotropia. Binocul Vis Strabismus Q. 2005; 20: 15-20 PubMed Google Scholar I have been disappointed with results from injection of one muscle in the setting of a maximal recession-resection procedure for very large comitant esotropia and exotropia (unpublished data) and attribute these results to poor vision in one eye (the reason a monocular procedure was performed) as well as the fact that only one muscle was injected with Botox (rather than 2 when bilateral recession is performed). Another reason I tend not to use the technique in the setting of a recession-resection procedure is because of the possibility of duction limitation and surgically induced enophthalmos from the amounts of resection necessary to treat very large deviations. I am surprised the authors listed only one patient in their series as having duction limitation (#10) and wonder whether postoperative enophthalmos was an issue for any of their patients.