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Vejbrink Kildal V, Rodriguez-Lorenzo A, Pruidze P, Reissig L, Weninger WJ, Tzou CHJ, Jonsson L, Meng S. Ultrasound-Guided Injections for Treatment of Facial Paralysis Sequelae: A Randomized Study on Body Donors. Plast Reconstr Surg 2024; 153:617e-625e. [PMID: 37285208 DOI: 10.1097/prs.0000000000010802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Botulinum toxin injection is the accepted standard treatment for synkinesis and gustatory hyperlacrimation in patients with facial paralysis. However, poor injection accuracy can result in inconsistent treatment outcomes, variable treatment durations, and complications. Ultrasound guidance should increase injection accuracy in the facial region; however, this has not been proven. METHODS Twenty-six hemifaces of nonembalmed cadavers were studied in a randomized split-face manner. Ink was injected with ultrasound or landmark guidance into the lacrimal gland and three common synkinetic muscles: the orbicularis oculi, depressor anguli oris, and mentalis. Injection accuracy was evaluated using several measures. RESULTS Using ultrasound guidance, most ink (>50%) was found inside the correct target in 88% of cases, compared with 50% using landmark guidance ( P < 0.001). This was most pronounced in the lacrimal gland (62% versus 8%), depressor anguli oris (100% versus 46%), and mentalis (100% versus 54%) ( P < 0.05). All ink was found inside the correct target (no ink outside) in 65% using ultrasound guidance versus 29% without ( P < 0.001). Injection accuracy (any ink in target) was 100% when using ultrasound guidance versus 83% without ( P < 0.01). Twenty-three percent of the landmark-guided depressor anguli oris injections stained the facial artery ( P = 0.22). CONCLUSIONS Ultrasound guidance significantly increased injection accuracy and reduced the amount of ink lost in the surrounding tissue compared with landmark guidance. Clinical trials are needed to explore the effects of ultrasound guidance on treatment outcome, duration, and complications in patients with facial paralysis.
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Affiliation(s)
| | | | | | | | | | - Chieh-Han John Tzou
- Uppsala, Sweden; and Vienna, Austria
- From the Department of Surgical Sciences, Plastic and Maxillofacial Surgery
- Otorhinolaryngology-Head and Neck Surgery, Uppsala University
- Division of Anatomy, Medical University of Vienna
- BioImaging Austria (CMI)
- Plastic and Reconstructive Surgery, Department of Surgery, Hospital of Divine Savior (Krankenhaus Goettlicher Heiland)
- Faculty of Medicine, Sigmund Freud University
- Facial Palsy Center, Tzou Medical
- Radiology, Hanusch Hospital
| | - Lars Jonsson
- Otorhinolaryngology-Head and Neck Surgery, Uppsala University
| | - Stefan Meng
- Division of Anatomy, Medical University of Vienna
- Radiology, Hanusch Hospital
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Hufendiek K, Bredt M, Binter M, Rosenstein C, Greb O, Wiezorrek M, Framme C, Schittkowski M, Hufendiek K. Characterization and Classification of Postoperative Cysts After Strabismus Surgery: Clinical, Histological, and Anterior Segment OCT Analysis in a Large German Cohort. Ophthalmol Ther 2023; 12:3233-3249. [PMID: 37773478 PMCID: PMC10640603 DOI: 10.1007/s40123-023-00808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
INTRODUCTION In this work, we provide a detailed characterization of a rare complication-subconjunctival cyst formation after strabismus surgery-in a large German cohort. METHODS We conducted a retrospective analysis of 822 consecutive patients who underwent strabismus surgery between 2015 and 2022. The patients received comprehensive eye and orthoptic examinations preoperatively, at 1 day, and at 3 months postoperatively. Cysts were analyzed with slit-lamp examination, anterior segment optical coherence tomography (AS-OCT), and histopathological subsumption. RESULTS Nineteen cases of postoperative cysts were observed (2.3%), 12 of which underwent surgical revision. Clinical evaluation including slit-lamp and AS-OCT as well as histological analysis resulted in a classification of three types of cysts: type 1, which is a single hyporeflective cyst, type 2, which is a multilobular hyporeflective cyst, and type 3, a dense hyperreflective granulomatous-like cyst. Eta (η) correlation ratio analysis could show a correlation between time of clinical appearance and type of cyst (Eta = 0.63). Most cysts developed within 20 days after surgery. Not only did cysts more frequently affect the medial rectus muscle, which in most cases underwent a shortening procedure (11/19 tucks, 4/19 resections) for intermittent exotropia (X(T)), but the cyst also formed earlier than in the lateral rectus muscle (Eta = 0.45). No correlation could be shown between the type of surgical procedure and time of cyst occurrence (Eta = 0.1). Patient age and cyst type correlated strongly (Eta = 0.47). The underlying type of strabismus did not correlate with the type of cyst observed. CONCLUSIONS Our cases showed a strong positive correlation to the type of strabismus (X(T)), age (young patients), and the procedure (tuck/resection). We introduce a grading system for postoperative cysts after strabismus surgery, complementing histopathology and slit-lamp aspects with AS-OCT information.
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Affiliation(s)
- Karsten Hufendiek
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Martin Bredt
- Institute of Pathology, Medizinische Hochschule Hannover, Hannover, Germany
| | - Maximilian Binter
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Christopher Rosenstein
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Oliver Greb
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Mareile Wiezorrek
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Carsten Framme
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Michael Schittkowski
- Department of Ophthalmology, Section for Strabismus and Neuroophthalmology, University Medical Center Göttingen, Göttingen, Germany
| | - Katerina Hufendiek
- University Eye Hospital, Universitätsklinik für Augenheilkunde, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Aljohani S, AlJaloud A, Alsakran WA, AlZaid A. INADVERTENT GLOBE PENETRATION AND SUBRETINAL INJECTION OF BOTULINUM TOXIN IN A PATIENT WITH OCULOCUTANEOUS ALBINISM. Retin Cases Brief Rep 2023; 17:302-304. [PMID: 34001765 DOI: 10.1097/icb.0000000000001160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
Abstract
PURPOSE To present a case of localized retinal detachment and mild vitreous hemorrhage in a patient with oculocutaneous albinism after accidental intraocular injection of botulinum toxin A. METHODS Botulinum toxin A injection was administered to a 5-year-old patient with oculocutaneous albinism with esotropia and resulted in an ocular penetration. Dilated fundus examination indicated a nasal retinal tear causing a mild vitreous hemorrhage and a localized retinal detachment. RESULTS No treatment was required for the retinal detachment, and we observed the patient at regular intervals. On Day 1, the detachment resolved spontaneously without sequelae. On follow-up, scarring at the lesion site was detected at one month after the incidence, and the patient's vision was stable. CONCLUSION In this instance, observation was sufficient for our patient with complete resolution of retinal detachment and no long-term complication. Botulinum toxin A did not seem toxic to intraocular tissues. However, intramuscular botulinum toxin A injection should be administered carefully. Oculocutaneous albinism did not seem to affect the final outcome in our case.
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Affiliation(s)
- Saud Aljohani
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Imam Abdulrahman Bin Faisal University, Ophthalmology Department, Dammam, Saudi Arabia; and
| | - Ahmad AlJaloud
- Pediatric Ophthalmology Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Wael A Alsakran
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulrahman AlZaid
- Vitreoretinal Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Wangtiraumnuay N, Surukrattanaskul S, Surakiatchanukul T, Masaya-Anon P, Hiriotappa J. Outcomes of pediatric accommodative esotropia with botulinum toxin A treatment in Thailand. Strabismus 2021; 29:26-33. [PMID: 33404269 DOI: 10.1080/09273972.2020.1871379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Accommodative esotropia is a condition commonly encountered by pediatric ophthalmologists. Patient with accommodative esotropia wear hyperopic glasses to decrease accommodation which occasionally provide them with good vision without glasses. Children are known to have limited compliance with glasses and patching. Their limited cooperation can also lead to variability in angle measurement across visits and defer surgery. To cope with these challenges, our team offered botulinum toxin injection to the medial rectus as an optional treatment while waiting for compliance and deferring the surgery. This is retrospective study including data from 114 accommodative esotropia patients who were injected with botulinum toxin into the medial rectus between 2010 and 2017. Of these, 102 patients met the inclusion criteria. Almost half of the patients were boys (47.06%). The average angle deviation before injection was 40 prism diopters (PD). The post-injection angle averaged at 11 PD at 2 weeks, 19 PD at 3 months, and 25 PD at 6 months. At 6 months, 51 patients (50.00%) had satisfactory results, 17 (16.67%) had excellent results (ortho to esotropia < 10 PD) and 34 (33.33%) had small angle esotropia (esotropia 11-20 PD). All complications including ptosis (37.25%), exotropia (11.76%), and hypertropia (4.9%) were reversible. Botulinum toxin injection into the medial rectus for pediatric esotropia showed satisfactory outcomes in 50% of patients with minimal complications. The study showed no significant association of good outcomes with age at onset, age during injection, status of development, status of amblyopia, refractive error, and angle of deviation as analyzed by the statistical package for social sciences.
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Affiliation(s)
| | | | | | | | - Juthathip Hiriotappa
- Department of Ophthalmology, Queen Sirikit National Institute of Child Health, Bangkok
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Yang HK, Kim DH, Hwang JM. Botulinum toxin injection without electromyographic guidance in consecutive esotropia. PLoS One 2020; 15:e0241588. [PMID: 33180838 PMCID: PMC7660504 DOI: 10.1371/journal.pone.0241588] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 10/16/2020] [Indexed: 11/24/2022] Open
Abstract
Purpose To investigate the efficacy of botulinum toxin injection without electromyographic guidance for the treatment of consecutive esotropia. Methods A retrospective study was performed on 49 subjects with consecutive esotropia who received botulinum toxin injection in the medial rectus muscles without the use of electromyographic guidance. Treatment was considered successful if the final ocular alignment was orthotropic or esodeviation was ≤10 prism diopters (PD) during distant fixation. Results The mean age was 15.2 ± 8.3 years. The mean esodeviation before injection was 21.8 ± 9.1 PD at distance and 21.3 ± 8.3 PD at near. The mean number of injections per patient was 1.3 ± 0.7, and 46 patients (93.9%) received two or fewer injections. At 6 months after the final injection, the mean angle of esodeviation was 7.3 ± 6.0 PD at distance and 7.5 ± 6.6 PD at near (all p<0.001), and 69.4% showed successful alignment. By multivariate analysis, an initial postoperative esodeviation of ≤18 PD at one month after exotropia surgery was considered to be a predictive factor for successful botulinum toxin injection (P = 0.007). Vertical deviation and/or ptosis occurred in 4 patients (8.2%) at two weeks after injection, which all resolved within three months. There was no recurrence of exotropia up to the final follow-up examination. Conclusion Botulinum toxin injection without electromyographic guidance is safe and effective in the treatment of consecutive esotropia without causing recurrent exotropia. Successful botulinum toxin injection is likely in patients with an initial postoperative esodeviation of 18PD or less at one month after exotropia surgery.
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Affiliation(s)
- Hee Kyung Yang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hyun Kim
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong-Min Hwang
- Department of Ophthalmology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
- * E-mail:
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Ozkahraman Kirik M, Arslan E, Kirik F. Cilioretinal artery occlusion and anterior ischaemic optic neuropathy due to periocular botulinum toxin a injection: A case report. Australas J Dermatol 2020; 62:e76-e78. [PMID: 32815158 DOI: 10.1111/ajd.13426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 06/23/2020] [Accepted: 07/05/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Mehtap Ozkahraman Kirik
- Department of Otorhinolaryngology-Head and Neck Surgery, Facial Plastic Surgery, Private Levent Hospital, Istanbul, Turkey
| | - Enver Arslan
- Department of Neurology, Private Avcilar Baypark Hospital, Istanbul, Turkey
| | - Furkan Kirik
- Faculty of Medicine Department of Ophthalmology, Bezmialem Vakif University, Istanbul, Turkey
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Yan MK, Kocak E, Yoong K, Kam JK. Ocular injuries resulting from commercial cosmetic procedures. Clin Exp Optom 2020; 103:430-433. [DOI: 10.1111/cxo.12952] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/02/2019] [Accepted: 07/12/2019] [Indexed: 12/28/2022] Open
Affiliation(s)
- Mabel K Yan
- Department of Ophthalmology, The Alfred Hospital, Melbourne, Victoria, Australia,
| | - Enis Kocak
- Department of Ophthalmology, The Alfred Hospital, Melbourne, Victoria, Australia,
| | - Kevin Yoong
- Department of Ophthalmology, The Alfred Hospital, Melbourne, Victoria, Australia,
| | - Jonathan K Kam
- Department of Ophthalmology, The Alfred Hospital, Melbourne, Victoria, Australia,
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The whole truth about botulinum toxin - a review. Postepy Dermatol Alergol 2019; 37:853-861. [PMID: 33603602 PMCID: PMC7874868 DOI: 10.5114/ada.2019.82795] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/06/2019] [Indexed: 11/17/2022] Open
Abstract
Treatment with botulinum toxin is widely viewed as safe, effective and largely devoid of serious side effects. There are two classes of Botox-related adverse events – transient and benign events, and potentially serious events. The aim of this study was to provide an overview of Botox-related side effects and advise potential management and preventive strategies. Benign side effects are well-localized, reversible and self-limited complications which develop within a few days of the injection, and they usually disappear without any treatment. The aesthetic and functional adverse effects are associated with different muscle responses to botulinum toxin or with misplacement of botulinum toxin. The serious events are sequelae due to the systemic spread of toxin leading to botulism.
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