Abstract
We have treated 12 unilaterally aphakic patients, with a manifest squint and binocular diplopia, with botulinum toxin injection to the appropriate horizontal rectus muscle, in an attempt to reduce the angle of squint and thereby resolve the diplopia. In all cases a short-term reduction in the angle of squint was achieved. In nine patients, whose aphakia was corrected with a contact lens, and eight of whom had had their lenses removed because of trauma, this reduction was only temporary. In three patients, however, who had had a non-traumatic cataract removed, replaced with a posterior chamber implant, control of the deviation was maintained long after the acute effect of the toxin had disappeared, with the development of coarse binocular single vision, a fusion range, and abolition of all diplopia. The possible reasons for these different responses are discussed and it is suggested that in cases of binocular diplopia following lens extraction, botulinum toxin treatment should be considered prior to any extraocular muscle surgery, as temporary reduction of the deviation may be sufficient to allow recovery of binocular single vision.
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Elston JS, Lee JP, Powell CM, Hogg C, Clark P : Treatment of strabismus in adults with botulinum toxin A. Br J Ophthalmol 1985, 69: 718–24.
Pratt-Johnson JA and Tillson G : Intractable diplopia after vision restoration in unilateral cataract. Am J Ophthalmol 1989, 107: 23–6.
Jain IS, Mohan K, Gupta A : Unilateral aphakia in children: Role of corneal contact lenses. J Pediatr Ophthalmol Strabis 1985, 22: 137–9.
Ridley F : Contact lenses in unilateral aphakia. Trans Ophthalmol Soc UK 1953, 73: 373–86.
Lyle TK : The importance of orthoptic investigations before contact lens fitting in unilateral aphakia—a preliminary report. Trans Ophthalmol Soc UK 1953, 73: 387–98.
Harwerth RS, Smith EL, Duncan GC, Crawford MLJ, Von Noorden GK : Multiple sensitive periods in the development of the primate visual system. Science 1986, 232: 235.
Bielschowsky, A : Congential and acquired deficiencies of fusion Am J Ophthalmol 1935, 18: 925.
Lubkin V and Linksz A : A ten-year study of binocular fusion with spectacles in monocular aphakia. Am J Ophthalmol 1977, 84: 700–7.
Hamed LM, Helveston EM, Ellis FD : Persistent binocular diplopia after cataract surgery. Am J Ophthalmol 1987, 103: 741–4.
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Hakin, K., Lee, J. Binocular diplopia in unilateral aphakia: The role of botulinum toxin. Eye 5, 447–450 (1991). https://doi.org/10.1038/eye.1991.72
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DOI: https://doi.org/10.1038/eye.1991.72
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