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Sjoukje E Loudon, Gerdien Holtslag, Huibert Jan Simonsz; Botulinum toxin as adjuvant to rectus muscle surgery in high myopia. Invest. Ophthalmol. Vis. Sci. 2022;63(7):3666 – A0323.
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© ARVO (1962-2015); The Authors (2016-present)
Botulinum Toxin (BTX) offers the possibility to temporarily release the contracture of the muscle enabling a far greater effect of surgery. We report on a novel application for BTX in 2 patients with esotropia-associated high myopia (EAHM) to increase effectiveness and long-term stability after surgery.
The first patient had long standing slowly progressive esotropia of 61 degrees with limited abduction in both eyes: 40 degrees abduction in the RE, 35 degrees abduction in the LE. High myopia was present in both eyes: RE S-14, and LE S-13 with an axial length of 30.88mm and 29.34mm, respectively. Visual acuity was 20/20 in both eyes. He was given 2.5 units of BOTOXTM in the Medial Rectus of the LE followed by 8mm resection of the Lateral Rectus of the LE 2 weeks later. A second surgery was conducted 3 months later on the other eye: 2.5 units of BOTOXTM in the Medial Rectus of the RE followed by an 8mm resection of the Lateral Rectus of the RE 2 weeks later. The second patient had an esotropia of 30 degrees. Abduction was limited in both eyes to 30 degrees. She had undergone previous strabismus surgery at the age of 44 years on the RE (5mm recession of the Medial Rectus and 3.5mm resection of the Lateral Rectus). High myopia was present in the RE of S-17 with an axial length of 33.06mm. Myopia in the LE was S-9 with an axial length of 27.19mm. Visual acuity in the RE was poor: counting fingers. Visual acuity in the LE was 20/20. She was given 2.5 units of BOTOXTM in the Medial Rectus of the RE followed by 7.5mm resection of the Lateral Rectus of the RE 2 weeks later. All procedures in both patients were performed under general anesthesia.
In the first patient we found an overall reduction of esotropia of 57 degrees: post-op results after the first surgery showed a remaining esotropia of 27 degrees in primary position. Six months after the second surgery there was a minimal angle of esotropia of 4 degrees with minimal abduction limitation. In the second patient the esotropia had improved with 18 degrees, to a remaining 12 degrees of esotropia with an improved abduction 6 months later.
We found a large reduction in esotropia using BTX as adjuvant to a resection of the rectus muscle in patients with EAHM. So in addition to the reported applications for BTX, it can also have an important role in increasing the success of surgery in patients with high myopia.
This abstract was presented at the 2022 ARVO Annual Meeting, held in Denver, CO, May 1-4, 2022, and virtually.
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