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Abstract #8701 Published in IGR 5-1
Botulinum A toxin injection for restrictive myopathy of thyroid-related orbitopathy: effects on intraocular pressure
Kikkawa DO; Cruz RC Jr; Christian WK; Rikkers S; Weinreb RN; Levi L; Granet DBAmerican Journal of Ophthalmology 2003; 135: 427-431
PURPOSE: To study the effect of extraocular muscle injections of botulinum A toxin on intraocular pressure (IOP) in patients with thyroid-related orbitopathy. DESIGN: Retrospective observational case series. METHODS: The medical records of eight consecutive patients with restrictive myopathy secondary to thyroid related orbitopathy (TRO) who underwent botulinum A toxin injection from December 1997 to December 1998 were reviewed and analyzed retrospectively. All patients were seen at the University of California, San Diego (UCSD) Thyroid Eye Center, a university-based tertiary referral center. The main outcome measure was IOP readings taken before and after injection in both primary gaze and upgaze (involving one eye in seven of the patients and both eyes in one patient). IOP readings were measured by an unmasked physician using a Goldmann applanation tonometer. RESULTS: A statistically significant decrease in IOP in upgaze was noted two to six weeks following botulinum A toxin injection and in both fields of gaze (primary and upgaze) after two to four months. Mean IOP before injection was 21.4 ± 3.0 mmHg in primary gaze and 29.9 ± 9.7 mmHg in upgaze. Mean IOP following injection at two to six weeks, was 19.2 ± 4.2 mmHg (p < 0.095) in primary gaze and 25.1 ± 5.9 mmHg (p < 0.023) in upgaze. At two to four months following injection, mean IOP was 19.3 ± 3.9 mmHg (p < 0.044) in primary gaze and 27.7 ± 8.5 mmHg (p < .024) in upgaze. Six patients indicated improved ocular deviation, which was associated with a lowering of IOP. Two patients indicated no change in IOP or strabismic deviation following botulinum A toxin injection. CONCLUSIONS: Botulinum A toxin injections cause a secondary effect to lower IOP in patients with restrictive strabismus associated with thyroid-related orbitopathy.
Dr. D.O. Kikkawa, University of California, San Diego Thyroid Eye Center, San Diego, California 92093, USA. dkikkawa@ucsd.edu
Classification:
9.4.15 Glaucoma in relation to systemic disease (Part of: 9 Clinical forms of glaucomas > 9.4 Glaucomas associated with other ocular and systemic disorders)
