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Abstract

In his letter to the editor concerning our study on the augmentation effect of botulinum toxin A (BTA) on recession-resection surgery, 1 Özkan S.B. Topaloğlu A. Aydin S. The role of botulinum toxin A in the augmentation of the effect of recession and/or resection surgery. JAAPOS. 2006; 10: 124-127 PubMed Scopus (27) Google Scholar Arif O. Khan proposes that BTA works best intraoperatively when surgery entails bimedial recessions. 1 Özkan S.B. Topaloğlu A. Aydin S. The role of botulinum toxin A in the augmentation of the effect of recession and/or resection surgery. JAAPOS. 2006; 10: 124-127 PubMed Scopus (27) Google Scholar , 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 Khan reports the results of horizontal eye muscle surgery in combination with BTA injection in large-angle esodeviations in seven cases with bimedial recessions and in one case with recession-resection surgery. 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 Khan’s series, however, differs from ours in nontrivial ways. In his series, supramaximal medial rectus recessions of as much as 9 mm are performed on some patients. In our study, on the contrary, the extent of surgery remained within the conventional range. Another important point to consider is the follow-up time for assessment of the additive effect of BTA. The BTA effect may last for 6 to 9 months after BTA injection; however, in Khan’s series, the follow-up occurred before 9 months (3 to 7 months) in four out of eight patients—a shorter period than in our study. 1 Özkan S.B. Topaloğlu A. Aydin S. The role of botulinum toxin A in the augmentation of the effect of recession and/or resection surgery. JAAPOS. 2006; 10: 124-127 PubMed Scopus (27) Google Scholar , 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 , 3 Scott A.B. Rosenbaum A. Collins C.C. Pharmacologic weakening of extraocular muscles. Invest Ophthalmol. 1973; 12: 924-927 PubMed Google Scholar The final deviation of these patients could still in fact be affected by BTA; that is, deviation in these cases may yet recur.