Saranya, V R (2020) The Efficacy of Botulinum Toxin Injection in Acute Sixth Nerve Palsy: A Prospective Observational study. Masters thesis, Aravind Eye Hospital and Post Graduate Institute of Ophthalmology, Madurai.
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Abstract
BACKGROUND: Spontaneous resolution of sixth nerve palsy has been reported in many studies. Even though the patient improved symptomatically and functionally, there was no proper evidence for the efficacy of botulinum toxin injection so far. To provide more accurate assessment of recovery rate following botulinum toxin injection, we performed a prospective observational study. METHODS: This is a prospective observational study done on patients with acute sixth nerve palsy presenting within six weeks of onset to the paediatric ophthalmology and neuro-ophthalmology department in Aravind Eye Hospital, Madurai between January 2018 and May 2019. The patients were explained about both botox injection and conservative options. Patients who gave consent for botox injection were enrolled in botox group and remaining in conservative group. A standard of 5 IU botox injection was given directly into the muscle belly under direct observation. Recovery at 6 months was observed in both groups which was defined as absence of diplopia in primary position and less than or equal to 10 PD distance esotropia in primary position. RESULTS: Majority of the patients (53.8%) were between 41 and 60 years of age and the remaining (36.3%) were above 60 years of age. There was a male predominance (73.6%) in both groups taken together. Out of 91 patients, 78% had an underlying microvascular etiology. In this study, the patients who presented with an initial deviation of 21-40 Prism Dioptres in botox and conservative group had a mean recovery of 16.3±7.1 and 21.6±8.1 weeks respectively. The p value (0.038) showed a significant difference in mean recovery between the two groups. The sub categorical assessment made on the onset of presentation, abduction deficit and various systemic risk factors in both groups showed no statistical significance (p > 0.05). However, the overall percentage of recovery remained the same in both groups. CONCLUSION: The overall recovery rate was similar in botox and conservative group. However in cases ischemic paresis with presenting deviation 21-40 prism dioptres, injection of botulinum toxin hastened the mean recovery rate significantly. In view of benefit and no disadvantage, botulinum injection can be considered in cases of acute ischemic sixth nerve palsy to alleviate symptoms of diplopia and to provide a functionally better recovery period.
| Item Type: | Thesis (Masters) |
|---|---|
| Additional Information: | 221713459 |
| Uncontrolled Keywords: | Efficacy, Botulinum Toxin Injection, Acute Sixth Nerve Palsy, Prospective Observational study. |
| Subjects: | MEDICAL > Ophthalmology |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Feb 2021 16:27 |
| Last Modified: | 14 Feb 2021 16:27 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/14210 |
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