Abstract | PURPOSE: To evaluate the clinical effectiveness and anatomic changes resulting from bupivacaine injection into extraocular muscles to treat comitant horizontal strabismus. DESIGN: Prospective, observational clinical series. PARTICIPANTS: Thirty-one comitant horizontal strabismus patients. METHODS: MAIN OUTCOME MEASURES: Clinical alignment measures and muscle volume, maximum cross-sectional area, and shape derived from magnetic resonance imaging, with follow-up examinations for up to 3 years. RESULTS: At an average of 15.3 months after the final treatment, original misalignment was reduced by 10.5 prism diopters (Δ; 6.0°) with residual deviations of 10Δ or less in 53% of patients. A single treatment with bupivacaine alone reduced misalignment at 11.3 months by 4.7Δ (2.7°) with residual deviations of 10Δ or less in 50% of patients. Alignment corrections were remarkably stable over follow-ups for as long as 3 years. Six months after bupivacaine injection, muscle volume had increased by 6.6%, and maximum cross-sectional area had increased by 8.5%, gradually relaxing toward pretreatment values thereafter. Computer modeling with Orbit 1.8 (Eidactics, San Francisco, CA) suggested that changes in agonist and antagonist muscle lengths were responsible for the enduring changes in eye alignment. CONCLUSIONS:
Bupivacaine injection alone or together with botulinum toxin injection in the antagonist muscle improves eye alignment in comitant horizontal strabismus by inducing changes in rectus muscle structure and length.
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Authors | Joel M Miller, Alan B Scott, Kenneth K Danh, Dirk Strasser, Mona Sane |
Journal | Ophthalmology
(Ophthalmology)
Vol. 120
Issue 12
Pg. 2733-2740
(Dec 2013)
ISSN: 1549-4713 [Electronic] United States |
PMID | 23916485
(Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2013 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved. |
Chemical References |
- Anesthetics, Local
- Neuromuscular Agents
- Botulinum Toxins, Type A
- Bupivacaine
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Topics |
- Adult
- Aged
- Aged, 80 and over
- Anesthetics, Local
(administration & dosage)
- Botulinum Toxins, Type A
(administration & dosage)
- Bupivacaine
(administration & dosage)
- Drug Therapy, Combination
- Electromyography
- Female
- Follow-Up Studies
- Humans
- Injections, Intramuscular
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neuromuscular Agents
(administration & dosage)
- Oculomotor Muscles
(drug effects, physiology)
- Prospective Studies
- Strabismus
(drug therapy, physiopathology)
- Treatment Outcome
- Vision, Binocular
(physiology)
- Young Adult
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