Botulinum toxin as an adjunct to monocular recession-resection surgery for large-angle sensory strabismus.

PURPOSE

To evaluate the result of using intraoperative botulinum toxin A (BTA) as an adjunct to monocular recession-resection surgery in the management of large-angle sensory strabismus.

METHODS

The medical records of patients diagnosed with sensory strabismus with constant large-angle strabismus were reviewed retrospectively to identify those who underwent monocular recession-resection surgery combined with 5 units of BTA injection into the recessed muscle of the nonfixating eye. Surgical outcome was considered successful if the final deviation was within the range of 0-10.

RESULTS

A total of 13 patients (mean age, 31.04 ± 18.5 years) were included, 8 with exotropia and 5 with esotropia. The mean follow-up period was 52.77 ± 10.9 months. The mean preoperative deviation was 66 ± 16 in the esodeviation group and 56 ± 5 in the exodeviation group. The final postoperative mean deviation was 6 ± 7 in the esodeviation group and 6 ± 8 in the exodeviation group. There were 7 patients (87.5%) with final deviation of ≤10 in the exodeviaton group and 4 (80%) in the esodeviation group.

CONCLUSIONS

Adjunctive usage of BTA with conventional surgery appears to enhance surgical outcomes by increasing the amount of expected correction. The combined use of BTA with monocular recession-resection rectus muscle surgery may be a good alternative in the treatment of large-angle sensory strabismus with the advantage of less risk of potential complications compared to supramaximal surgery or surgery in the "good" eye.