Bupivacaine and botulinum toxin to treat comitant strabismus

Abstract

Purpose: To evaluate the change in ocular motility and muscle thickness measured with ultrasonography after intramuscular injection of bupivacaine and botulinum toxin A. Methods: Eight patients (five female) were enrolled to measure ocular motility prior and 1, 7, 30 and 180 days after one injection of 2 ml of 1.5% bupivacaine and 2.5 U of botulinum toxin A in agonist and antagonist muscles, respectively, of eight amblyopic eyes. Muscle thickness was measured prior and on days 1, 7 and 30 after injection using 10MHz ultrasonography (eyelid technique). Results: Mean change in alignment was 10 prism diopters after 180 days (n=6). An average increase of 1.01 mm in muscle thickness was observed after 30 days of bupivacaine injection and 0.28 mm increase was observed after botulinum toxin A injection, as measured by ultrasonography. Lateral rectus muscles injected with bupivacaine had a mean increase of 1.5 mm in muscle thickness. Conclusion: In this study, a change in ocular motility was observed after 180 days of intramuscular injection of bupivacaine and botulinum toxin in horizontal extraocular muscles. Overall, there was an increase of muscle thickness in both botulinum toxinum A and bupivacaine injected muscles after 30 days of injection when measured by ultrasonography. This change was more pronounced on lateral rectus muscles after bupivacaine injection.

Flavonoids Sophoranone Promotes Differentiation of C2C12 and Extraocular Muscle Satellite Cells

“…For this reason, drugs such as botulinum toxin A (BTXA) and bupivacaine (BPX) have been used as clinical alternatives to surgery as a means to chemically weaken and strengthen EOMs, respectively. Such drug treatments may promote changes in muscle biomechanics and muscle satellite cell proliferation not attainable with surgery [20, 21]. Other approaches used in the treatment of strabismus include cell growth factors which have been investigated both in vitro and in animal models [22-28].…”

Lidocaine Inhibits Myoblast Cell Migration and Myogenic Differentiation Through Activation of the Notch Pathway

“…One hypothesis that has been proposed to explain the effects of local anesthetics in strabismus treatment is that there is a selective damage to muscle fibers of the EOMs while preserving cellular support structures, nerves and satellite cells. 11 Subsequently, these satellite cells activate myoblasts to initiate a rapid process of regeneration. 12 While it is not entirely clear as to the means through which local anesthetics affect satellite cells or myoblasts, there is evidence from previous studies that these local anesthetics can be cytotoxic to myoblasts through their ability to induce anti-proliferation and cell death.…”