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The Efficacy and Complications of Botulinum A Toxin in the Treatment of Horizontal Strabismus
Habtezion, Henoch David |
Recenzentas / Reviewer | |
Komisijos pirmininkas / Committee Chairman | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member | |
Komisijos narys / Committee Member |
Author: Henoch David Habtezion Title: The Efficacy and Complications of Botulinum A Toxin in The Treatment of Horizontal Strabismus Aim of the thesis: To select and analyse scientific articles describing the efficacy and complications of botulinum A toxin injections for treatment of horizontal strabismus. Objectives of the thesis: To determine if botulinum A toxin injections can achieve satisfactory resolution (defined as a reduction of ≥10 prism dioptres [PD]) of horizontal strabismus at least 6 months after the intervention, comparatively to surgical interventions. To determine how long botulinum A toxin injections’ effect on horizontal strabismus lasts. To determine if there are any side effects with botulinum A toxin injections; and if so, identify which ones. Method: This systematic literature review is structured according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The online database „PubMed” was used to search for scientific publications. The key words used to search were: (Botulinum toxin OR Botulinum A toxin OR Pharmacological management) AND (Strabismus OR infantile esotropia OR exotropia OR intermittent exotropia OR convergence strabismus OR acute onset esotropia OR residual esotropia OR divergence strabismus). The publications were collected according to the PICOS (population, interventions, comparative, results, study design) system. Exclusion and inclusion criteria were written based on PRISMA and those written in the LSMU regulations. Included publications were analysed. Results: Out of 162 publications, 34 full publications were analysed and 4 publications fulfilled the criteria and were selected for this systematic literature review. H. Gursoy MD. et al. 2012 [1] and M. J. Wan et al. 2017 [2] compared the safety and efficacy of botulinum A toxin injections with conventional medial rectus recession. Neither of them found any statistically significant difference in efficacy nor complications between the two treatment options (68% vs 67%, on average, respectively). The remaining two publications (J. Chen et al. 2013 [3] and M. E. Razavi et al. 2014 [4]) performed no comparisons and had a much lower success rate (38%), but their definition of successful treatment differed from the ones in this literature review and from the first two publications mentioned. Conclusion: Both incisional surgery and botulinum A toxin injections treat horizontal strabismus with a satisfyingly high efficacy and no statistically significant difference in efficacy nor complications between the two. The most common complications of botulinum A toxin injections reported were transient ptosis, diplopia, vertical deviation, overcorrection, abduction deficiency, and significant inferior oblique muscle overaction. Recommendations: The sample sizes of the reviewed publications were too small to recommend a change in the first line treatment of horizontal strabismus, but the low cost and minimal scarring makes it an attractive option for the sake of cost saving and patients expected to need multiple interventions.
Šioje literatūros apžvalgoje tiriamas botulino toksino injekcijų veiksmingumas ir komplikacijos gydant horizontalųjį žvairumą. 4 naujausios publikacijos analizuojamos ir lyginamos tarpusavyje pagal trumpalaikį ir ilgalaikį veiksmingumą, taip pat komplikacijų pobūdį ir dažnį, palyginti su chirurgija. Imties dydis yra nedidelis, tačiau statistiškai reikšmingo skirtumo tarp injekcijų ir operacijos nebuvo tiek veiksmingumo, tiek komplikacijų atžvilgiu. Todėl dėl mažos injekcijos siūlomos kainos ir minimalių randų neišvengiama didelio kontrolinio tyrimo poreikio.