augmented recession by intraoperative botulinum toxin-a injection in large angle horizontal deviation

purpose : the aim of this study is to evaluate the effectiveness of intraoperative botulinum toxin-a (bta) injection as an adjunct to the surgical treatment of large-angle esotropia or exotropia. methods : thirteen patients were included in this interventional case series study. mean age of the patients was 23.31±13.29 years (range: 5-43 years). of these 13 patients, 6 were exotropic and 7 were esotropic. the average preoperative esodeviation was 79.29±16.44 prism diopters (pd) (range: 60-100 pd) and exodeviation was 75.83±11.14 pd (range: 65-90 pd). depending on the degree of deviation ten or twenty units of dysport were injected intraoperatively into the recessed horizontal rectus muscles in all of the patients. results : the average follow-up was 7±1 months (range: 6-8 months). the average final deviation in the esotropia group was 8.57±10.69 pd of esotropia. the average final deviation in the exotropia group was 14.17±12.00 pd of exotropia. the final deviation of the 69% patients was within 15 pd of esotropia or exotropia. conclusion : this study shows that the combination of bta injection with recession may be a useful treatment option in cases of large angle horizontal deviation.   iranian journal of ophthalmology 200921(1):47-51 © 2009 by the iranian society of ophthalmology