Díaz-Flores T, Romero-Apis D, Pérez-Pérez JF

Language: Spanish
References: 13
Page: 26-30
PDF size: 141.01 Kb.

ABSTRACT

Introduction: Paralytic strabismus in diabetic patients is more common in adults and more frequent in those with a long history of diabetes. It affects the cranial nerves III, IV and VI. Methods: We analyzed data from the clinical records of the Strabismus Service of the Instituto Mexicano de Oftalmología, from January 2015 to March 2017, looking for patients with diagnosis of oculomotor nerves palsy (III, IV, VI). We also analyzed the evolution between the patients treated with botulinum toxin injection and those without treatment (observation). Descriptive statistics parameters were analyzed. Results: The most frequent etiology of oculomotor palsies was the microvascular with 76%. The most affected cranial nerve in the general population was the VI nerve with 41.33%. The most affected cranial nerve in diabetic patients was the III cranial nerve with 24 cases, followed by the VI cranial nerve with 22 cases and the least affected was the IV cranial nerve with 7 cases. Botulinumtoxin was applied to 17 patients and 36 patients were observed without treatment. Of the 17 patients that required injection, 5 had paralysis of the III cranial nerve and 12 of the VI cranial nerve. Conclusions: The III cranial nerve was the most affected in diabetic patients. Botulinum toxin is effective in the majority of cases and provides a fast and effective response. The response to botulinum toxin varies depending on the magnitude of the deviation, with a slower recovery in cases of greater deviation.

REFERENCES

1. Romero-Apis D. Estrabismo. Aspectos Clínicos y Tratamiento. DALA; 2010.

2. Al Kahtani ES, Khandekar R, Al-Rubeaan K, Youssef AM, Ibrahim HM, Al-Sharqawi AH. Assessment of the prevalence and risk factors of ophthalmoplegia among diabetic patients in a large national diabetes registry cohort. BMC Ophthalmology. 2016;16:118.

3. Yanovitch T, Buckley E. Diagnosis and management of third nerve palsy. Curr Opin Ophthalmol. 2007;18(5):373-8.

4. Fang C, Leavitt JA, Hodge DO, Holmes JM, Mohney BG, Chen JJ. Incidence and Etiologies of Acquired Third Nerve Palsy Using a Population- Based Method. JAMA Ophthalmol. 2017;135(1):23-8.

5. Akagi T, Miyamoto K, Kashii S, Yoshimura N. Cause and prognosis of neurologically isolated third, fourth, or sixth cranial nerve dysfunction in cases of oculomotor palsy. Jpn J Ophthalmol. 2008;52(1):32-5.

6. Tamhankar MA, Biousse V, Ying GS, Prasad S, Subramanian PS, Lee MS, et al. Isolated third, fourth, and sixth cranial nerve palsies from presumed microvascular versus other causes: a prospective study. Ophthalmology. 2013;120(11):2264-9.

7. Chan JW, Albretson J. Causes of isolated recurrent ipsilateral sixth nerve palsies in older adults: a case series and review of the literature. Clinical Ophthalmology. 2015;9:373-7.

8. Lozano TA, Hernández OT, Castillo OC, Fuente TMA. Uso de toxina botulínica subtenoniana en parálisis del sexto nervio craneal. Rev Mex Oftalmol. 2008;82(3):163-5.

9. Cáceres-Toledo M, Márquez-Fernández M, Cáceres-Toledo O, Hidalgo- Costa T, Ferrás-Bacallao Y, Zazo E. Tratamiento del estrabismo paralítico con toxina botulínica A. Rev Cubana Oftalmol. 2015;28(2):168-76.

10. Scott AB. Botulinum toxin injections into extraocular muscles as an alternative to strabismus surgery. Ophthalmology. 1980;87(10):1044-9.

11. Arroyo-Yllanes ME, Pérez-Pérez JF, Murillo-Murillo L. Resultados con la aplicación de toxina botulínica en pacientes con endotropía y retraso psicomotor. Cir Ciruj. 2009;77:9-12.

12. Dawson EL, Sainani A, Lee JP. Does botulinum toxin have a role in the treatment of secondary strabismus? Strabismus. 2005;13(2):71-3.

13. Hung HL, Kao LY, Sun MH. Botulinum toxin treatment for acute traumatic complete sixth nerve palsy. Eye. 2005;19(3):337-41.