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Original ArticleOpen Access
Botulinum Toxin A in Surgically Overcorrected and Undercorrected Strabismus
Wutthiphan S 
Objective: To evaluate the effectiveness and safety of botulinum toxin A injection in treating overcorrected and
undercorrected strabismus after unsatisfactory postoperative alignment.
Material and Method: The authors reviewed the outcomes of 20 patients aged 5 to 56 years (mean 29.1 years)
who had botulinum toxin A injection following their unsatisfactory operation. The motor outcomes (percentage
of successful motor outcome and percentage change in deviation) were recorded at 1 month, 3 months, 6
months, 1 year, 2 years, 3 years, and 4 years after botulinum toxin injection.
Results: The mean pre-botulinum toxin injection angle of deviation was 20.6 prism dioptors (PD). Six of 20
(30%) patients maintained the successful position for the average of 2.66 years (range 1-4 years) with single
injection. The mean percentage change of the deviation was 87.50%, 87.93 %, 73.05 % at 1, 2, and 3-year visit
respectively. In 3 of 5 (60%) patients of consecutive esotropia, 4 of 8 (50%) residual esotropia, 1 of 4 (25%)
of consecutive exotropia and 1 of 3 (33.33%) of residual exotropia had successful motor alignment at 6 month
visit. There was no scleral perforation, visual loss, or retrobulbar hemorrhage from the injection treatment in
the present study.
Conclusion: Botulinum toxin A injection appears to be a safe and effective treatment for overcorrected and
undercorrected strabismus after unsatisfactory surgery. It is very effective in rapid elimination postoperative
diplopia. When the result is not adequate or the effect does not last long, repeat the injection or reoperation
can be chose to perform later.
Keywords: Botulinum toxin, Consecutive esotropia, Residual esotropia, Consecutive exotropia, Residual
exotropia
undercorrected strabismus after unsatisfactory postoperative alignment.
Material and Method: The authors reviewed the outcomes of 20 patients aged 5 to 56 years (mean 29.1 years)
who had botulinum toxin A injection following their unsatisfactory operation. The motor outcomes (percentage
of successful motor outcome and percentage change in deviation) were recorded at 1 month, 3 months, 6
months, 1 year, 2 years, 3 years, and 4 years after botulinum toxin injection.
Results: The mean pre-botulinum toxin injection angle of deviation was 20.6 prism dioptors (PD). Six of 20
(30%) patients maintained the successful position for the average of 2.66 years (range 1-4 years) with single
injection. The mean percentage change of the deviation was 87.50%, 87.93 %, 73.05 % at 1, 2, and 3-year visit
respectively. In 3 of 5 (60%) patients of consecutive esotropia, 4 of 8 (50%) residual esotropia, 1 of 4 (25%)
of consecutive exotropia and 1 of 3 (33.33%) of residual exotropia had successful motor alignment at 6 month
visit. There was no scleral perforation, visual loss, or retrobulbar hemorrhage from the injection treatment in
the present study.
Conclusion: Botulinum toxin A injection appears to be a safe and effective treatment for overcorrected and
undercorrected strabismus after unsatisfactory surgery. It is very effective in rapid elimination postoperative
diplopia. When the result is not adequate or the effect does not last long, repeat the injection or reoperation
can be chose to perform later.
Keywords: Botulinum toxin, Consecutive esotropia, Residual esotropia, Consecutive exotropia, Residual
exotropia
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