Botulinum toxin offers favorable results for diplopia after cataract, refractive surgery

Paris—Investigators at the University of Florence, Florence, Italy, used injections of botulinum toxin into the appropriate muscles of patients who developed diplopia after cataract extraction or refractive surgery and retrospectively evaluated the results.

All patients had normal retinal function, according to Silvia Brogelli, MD. Dr. Brogelli reported at the annual meeting of the European Society of Cataract and Refractive Surgeons that all of the 25 patients who were treated from 1986 to 2002 included in the study had resolution of the diplopia in from 4 to 21 days (mean, 9 days).

Patients received 1.25 to 5 units of botulinum toxin type A (Botox, Allergan); 100 to 200 units of botulinum toxin type B (NeuroBloc, Elan Pharmaceuticals); or 2.5 to 5 units of botulinum toxin type A (Dysport, Ipsen Ltd.). The duration of the treatment response ranged from 1 month to 18 years.

Dr. Brogelli reported that 85% of the patients had stable vision and had at least 2 years during which they were free of diplopia. The number of injections ranged from one to eight. Fifteen percent of the patients were treated chronically with botulinum toxin, and these patients received injections three to four times annually.

Even though treatment with botulinum toxin, according to Dr. Brogelli, has fallen into disfavor recently, she pointed out that in their hands treatment of diplopia with botulinum toxin is effective.