Superior oblique paralysis: treatment by the botulinum toxin A compared to surgical treatment

Abstract

 

Purpose

 

The standard treatment for decompensated congenital paralysis of the superior oblique muscle and the acquired paralysis Still surgery. The using of botulinum toxin in this disease is not clear .There is no consensus up today. We recently reviewed in the context of a medical thesis our surgical results in paralysis of the superior oblique over twenty years .We found the efficiency of surgical treatment outcome with time seems to be diminish.We asked the interesting question of the role of botulinum toxin in this disease because of its low morbidity and its easy administration.

 

Methods

 

We undertook a prospective study including a homogeneous group of patients suffering from paralysis of the superior oblique were treated with botulinum toxin. Injection of 5 IU of botulinum toxin type A is made in the ipsilateral inferior oblique muscle under local anesthesia. This group is compared over time including objective and subjective clinical parameters with a group of patients treated by surgery for their superior oblique paralysis .These two groups each consist of ten patients .Mean age 30 y, 58% are male .Complete ophthalmologic examination is performed for each of them Pre-operative then one week, one month, three months, six months, one year then every year. Orthoptic criteria was analyzed deviation in primary position , measurements of maneuver Bielschowski, wall of Harms examination and Hess chart was done.

 

Results

 

The effectiveness of the toxin is felt after one week in the majority of patients with a reduction of diplopia .One case presented with horizontal diplopia because of diffusion of the toxin to lateral rectus muscle. The average efficiency of the toxin compared with surgery in the cylotorsion was superior at the first month and then over time the effect becomes comparable to surgery .The effectiveness in vertical deviation was greater in surgery. The analysis of the different criteria during more than six months did not find any significant difference between the two methods of treatment.

 

Conclusions

 

Treatment with botulinum toxin paralysis for decompensated paralysis of the superior oblique muscle appears as effective as surgery in the short term .This analysis may support treatment patient has acute post-traumatic paralysis by toxin.

 

 

Fig 1: average cylotorsion: comparing between surgical and injection toxin A for treatment Paralysis of superior oblique

 

Keywords: 522 eye movements • 725 strabismus: treatment • 521 extraocular muscles: structure