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Stephen P Christiansen; Novel therapies for strabismus. Invest. Ophthalmol. Vis. Sci. 201657(12):.
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© ARVO (1962-2015); The Authors (2016-present)
Presentation Description :
Strabismus surgery, at its essence, is an operation that either strengthens or weakens the effect of an extraocular muscle (EOM) by adjusting its mechanical advantage at its insertion. This results in a change in the rotational position of the globe, but it also creates permanent changes in the ocular motor plant that may be advantageous or deleterious in the long term. Because resting tonus across an agonist-antagonist pair changes with time, recurrent or consecutive strabismus is common. Ideally, strabismus treatment should adjust EOM strength without altering the ocular motor construct, thereby preserving normal EOM-globe and EOM-orbit relationships as long as possible so that future interventions, if required, may be as successful as possible. The use of botulinum toxin (BTX-A) has shown the clinical utility of a pharmacologic approach where EOM strength can be modulated without the need for incisional surgery. Newer agents can augment and extend the effectiveness of BTX-A, and investigational drugs hold promise for an armamentarium of agents that can be dosed and combined in such a way that ensures satisfactory short-term and long-term alignment can be achieved. If, at a future date, alignment deteriorates, pharmacological enhancement can be applied, all without the long-term alteration of EOM insertional biomechanics. Growth factors, toxins, and local anesthetics may all have their place in the future treatment of strabismus. Incumbent on current investigators is the need to not only demonstrate efficacy, but safety, especially in the use of these agents in infants and small children. We are at the dawn of a new era in the treatment of strabismus.
This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.
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