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Chemodenervation of extraocular muscles with botulinum toxin in thyroid eye disease

  • Oculoplastics and Orbit
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Abstract

Background

Thyroid eye disease (TED) presents a management dilemma for strabismologists due to the variability of its clinical course. Prisms may be prescribed to relieve diplopia in small deviations. Surgical intervention, on the other hand, should not be done until the active phase of the disease has subsided. We report our experience with chemodenervation utilizing botulinum toxin (BT) injection in the management of TED-related strabismus.

Methods

A retrospective chart review was done on twenty-two (22) consecutive patients receiving BT injections at the University of California, San Diego (UCSD) Thyroid Eye Center. All BT injections were administered by a single physician under electromyographic guidance.

Results

The clinical records of 22 patients (18 females) were reviewed. Seven patients (32 %) had a reduction of their deviation to a point where surgery was not required. In six patients (27 %), surgery was required but an improvement in ocular deviation was found, altering the original surgical plan. In four patients (18 %), the deviation continued to progress after BT injection. Success rates were higher if pre-treatment deviation was less than 20 prism diopters (∆).

Conclusion

One third of the chemodenervation-treated patients avoided surgical intervention, with an additional 27 % (total of 40 % of those who needed surgery) having a reduced deviation prior to surgery. Using BT injection to extraocular muscles to treat diplopia in TED patients is most effective in preventing surgery in those patients with 20∆ or less of deviation.

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Acknowledgments

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Department of Ophthalmology and The Thyroid Eye Center, University of California, San Diego, CA, USA

    David B. Granet, Nickisa Hodgson, Kyle J. Godfrey, Ricardo Ventura, Don O. Kikkawa & Michael Kinori

  2. Division of Ophthalmology, Scripps Clinic, La Jolla, CA, USA

    Leah Levi

Authors
  1. David B. Granet
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  2. Nickisa Hodgson
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  3. Kyle J. Godfrey
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  4. Ricardo Ventura
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  5. Don O. Kikkawa
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Corresponding author

Correspondence to David B. Granet.

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Funding

No funding was received for this research.

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge, or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional review board and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of study formal consent is not required. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.

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Granet, D.B., Hodgson, N., Godfrey, K.J. et al. Chemodenervation of extraocular muscles with botulinum toxin in thyroid eye disease. Graefes Arch Clin Exp Ophthalmol 254, 999–1003 (2016). https://doi.org/10.1007/s00417-016-3281-6

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  • DOI: https://doi.org/10.1007/s00417-016-3281-6

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