Document Detail

Subtenon injection of botulinum toxin for treatment of traumatic sixth nerve palsy.
MedLine Citation:
PMID:  12580268     Owner:  NLM     Status:  MEDLINE    
PURPOSE: Subtenon injection of botulinum toxin may produce results similar to intramuscular injection of the medial rectus muscle for the treatment of acute traumatic sixth nerve palsy. This study was designed to evaluate the clinical efficacy of subtenon injection and to compare our results with those in previously published reports. METHODS: During 3 years at a single institution, 13 patients with traumatic sixth nerve palsy of less than 6 months' duration were treated with subtenon injection of botulinum toxin. The deviation angles before and after injection were recorded. A distance esotropia of less than 10 prism diopters (PD) in the primary position or absence of diplopia at 3 months was defined as recovery. RESULTS: Of the 13 patients treated, 11 (84.5%) had unilateral palsy and 2 (15.4%) had bilateral palsy. The average pre-injection deviation was 39.5 PD of esotropia, and the average post-injection deviation was 17.0 PD. Seven patients experienced recovery and regained binocular single vision; the overall recovery rate was 53.8% (unilateral, 63.6%; bilateral, 0%). Six patients did not recover and subsequently underwent strabismus surgery. CONCLUSION: Patients with traumatic sixth nerve palsy treated with subtenon injection of botulinum toxin showed higher recovery rates than did most patients treated with conservative measures in published reports. The result of subtenon injection of botulinum toxin without electromyography (EMG) guidance was comparable to that obtained using EMG-guided intramuscular injection of botulinum toxin. Patients with unilateral palsy demonstrated a better recovery rate than did patients with bilateral palsy.
Ling Yuh Kao; An Ning Chao
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Journal of pediatric ophthalmology and strabismus     Volume:  40     ISSN:  0191-3913     ISO Abbreviation:  J Pediatr Ophthalmol Strabismus     Publication Date:    2003 Jan-Feb
Date Detail:
Created Date:  2003-02-12     Completed Date:  2003-03-06     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7901143     Medline TA:  J Pediatr Ophthalmol Strabismus     Country:  United States    
Other Details:
Languages:  eng     Pagination:  27-30     Citation Subset:  IM    
Division of Neuro-Ophthalmology, Department of Ophthalmology, Chang Gung Medical Center, Chang Gung University, Taipei, Taiwan.
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MeSH Terms
Abducens Nerve Diseases / drug therapy*,  etiology,  physiopathology
Abducens Nerve Injury / drug therapy*,  etiology,  physiopathology
Botulinum Toxin Type A / therapeutic use*
Connective Tissue / drug effects
Craniocerebral Trauma / complications
Diplopia / etiology,  physiopathology
Esotropia / etiology,  physiopathology
Middle Aged
Neuromuscular Agents / therapeutic use*
Oculomotor Muscles / innervation
Treatment Outcome
Reg. No./Substance:
0/Botulinum Toxin Type A; 0/Neuromuscular Agents

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