Toxina botulínica no tratamento de estrabismo horizontal em crianças com paralisia cerebral

Uso da toxina botulínica para correção de estrabismo

“…Allan Scott (6) in his pioneering work found good results in about 40% of patients with only one application. In a study by Cronemberger et al (11) , 80.9% of patients achieved deviations under 10 SD, decreasing to 53% after two years.…”

“…Abbasoglu et al (5) consider that results are affected by factors inherent to optical correction, secondary deviations, and amblyopia, among others, which can reduce the rates of therapeutic success in longer follow-up periods. However, Cronemberger et al (11) reported that muscle weakening can last from 2 weeks to 8 months with permanent change of ocular alignment depending on the concentrations of the injected drug. Therefore, a study with a more prolonged follow-up period may yield different results.…”

“…There are great variations in the literature with regard to treatment types, doses, and types of botulinum toxin (4,5,7,11,12) .…”

“…For strabismus it is indicated in horizontal deviations under 50PD, acute third and fourth nerve palsy secondary to Graves' ophthalmopathy, residual or consecutive deviations after strabismus surgery, deviations secondary to retinal detachment surgery, and in patients unfit for general anaesthesia or surgical repair (8,10,11) . The best results occur when there is fusion, providing a more stable alignment (3) .…”

“…The main advantage of BTA over surgery is administration under topical anaesthesia in adult patients or sedation in children, with little risk, lower cost, and no scars. Its disadvantages include transient ptosis and strabismus resulting from diffusion of the drug into surrounding muscles and, less frequently, scleral perforation, retrobulbar haemorrhage, and systemic effects (3,5,9,11) .…”