The aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) on intraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy (TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX -A injections were applied. Intraocular pressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2–4 weeks after BTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX -A injection using a Hertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6± 2.8 mmHg and 2–4 weeks after BTX-A injection was 16.9±3.3 mmH; (p=0.001). There was no statistically significant difference in Hertel egzophthalmometer readings before and after BTX-A injection, 21.5±2.7 mm vs 22.0± 2.6 mm; (p=0.678). In conclusion, BTX-A injection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influence on proptosis

Davor Galetović

Joško Leštin

Lovro Bojić

Milan Ivanišević

Mladen Lešin

Rinaldo Romac

Veljko Rogošić

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Coll. Antropol. 33 (2009) 4: 1155–1161Original scientific paperEffect of Botulinum Toxin-A Injectionon Intraocular Pressure and Proptosisin Thyroid Associated OrbitopathyMladen Le{in1, Lovro Boji}1, Rinaldo Romac2, Jo{ko Le{in3, Milan Ivani{evi}1, Davor Galetovi}1 andVeljko Rogo{i}11 Eye Department, University Hospital Center Split, Split, Croatia2 Department of Neurology, University Hospital Center Split, Split, Croatia3 Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Zagreb, CroatiaA B S T R A C TThe aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) onintraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy(TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX -A injections were applied. Intraocularpressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2–4 weeks afterBTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX -A injection using aHertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6± 2.8 mmHg and 2–4 weeks af-ter BTX-A injection was 16.9±3.3 mmH; (p=0.001). There was no statistically significant difference in Hertel egzoph-thalmometer readings before and after BTX-A injection, 21.5±2.7 mm vs 22.0± 2.6 mm; (p=0.678). In conclusion, BTX-Ainjection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influenceon proptosis.Key words: thyroid related orbitopathy, botulinum toxin-A, intraocular pressure, proptosisIntroductionThe thyroid associated orbitopathy (TAO) is charac-terized by proptosis and extraocular muscle involvementwhich can cause restrictive strabismus and increasedintraocular pressure (IOP)1.Causes of elevated IOP inpatients with TAO have been reported to be associatedwith the mechanical effect of extraocular thickening, ele-vated episcleral venus pressure, pressure of swollen or-bital tissues, accumulation of mucopolysaccharide in thetrabecular meshwork and finally coexistent open angleglaucoma2–7.Elevated IOP in up gaze is a common finding and isexplained by a tight inferior rectus muscle that blocksthe episcleral equeous outflow and orbital congestion2,8.It was found that in the Graves disease of recent unset,the raised muscle tension and reduced elasticity of the af-fected muscles, and hence strabismus, were caused pri-marily by active muscle contraction, not by fibrosis9.Treatment with botulinum toxin-A (BTX) in TAO hasbeen shown previously10–13. In a small retrospective se-ries of cases BTX-A caused decreased IOP on restrictivestrabismus associated with thyroid-related orbitopathy7.The aim of this study was to assess the effects ofBTX-A on IOP and proptosis in patients with TAO andrelated restrictive strabismus in observational case-study.Material and MethodsWe retrospectively studied the records of 17 patients(20 eyes, 14 female aged 49.9, range, 40–61 years and 3male aged 50.4, range, 50–57 years, with TAO and re-lated restrictive strabismus or diplopia treated at the De-partment of Ophthalmology University Hospital Splitduring the period from January 2004 to December 2006.Patient data are shown in Table 1.1155Received for publication June 20, 2007Before the therapy two patients were euthyroid andthe others were hyperthyroid. In the time of therapy theywere either euthyroid or with a stable hormonal status ofthe thyroid gland under medication for at least twomonths.Considering the time of initial complaints and theunset of the thyroid gland disease, 5 patients simulta-neously developed symptoms of the thyroid and eye dis-ease. Twelve patients developed eye symptoms after theunset of the thyroid gland disease.There were twelve active smokers. The median timeof duration of the eye signs of TAO was 11 months,ranged 9–15 months.All patients had a history of TAO based on the pres-ence of typical clinical ophthalmic findings (eyelid retrac-tion, limitation of ocular motility, strabismus, proptosisand computed tomography (CT) that revealed evidenceof extraocular muscle enlargement). All the patientswere with active TAO and according to CAS score werewith CAS 4 and more. Seven eyes were with CAS 4 and 5and 13 eyes with CAS 6 and 7.Botulinum toxin-A (Botox-Allergan) is a vial of 100units of the medication in the form of crystal powderwhich is dissolved with 1.0 ml 0.9% solution of natriumchloride so that 0.1 ml of the solution consists 10 IU ofBotulinum toxin A. 0.2 ml (20 IU) were applied with aninsulin syringe under topical anesthesia in the site of theinferior rectus muscle of the affected side.None of the patients was taking antiglaucoma medi-cations, glucocorticoids or was treated with orbital ra-diotherapy; only local supportive lubricants were used.Examination of all patients included in the study wasperformed before and 2–4 weeks after the treatment (vi-sual acuity, inspection of the eyelids and cornea, ocularmotility measurement, Hess-Lancaster test, ophthal-moscopy). Preinjection and postinjection IOP was mea-sured by an unmasked physican using a Goldmannaplanation tonometer in the primary position. Extra-orbital prominention of the eyeball was measured usinga Hertel instrument.Statistical analysis was performed using t-test, c²-test,Mann-Whitney U-test, Wilcoxon test, Mc Nemar test anddescriptive statistics.ResultsIOP and proptosis measured by Hertel egzophthal-mometry taken before and after the injection of BTX-Aare shown in Table 2.Before the injection, the mean IOP was 18.6±2.8 mmHg (range, 12–22 mmHg). After 2–4 weeks followingBTX-A injection, the mean IOP was significantly decrea-sed (16.9±3.3 mmHg, range 13–22 mmHg, p=0.001).Thedecrease in IOP was maintained in seventeen eyes forfour weeks of the observed period of time. In three eyesthe slight increase of IOP (1–3 mm Hg) was noticed twoweeks following BTX-A injection and maintained in theobserved period of four weeks. After BTX-A injection 8 ofthe eyes with CAS 6 and 7 reduced CAS score to 4 and 5(61.5 %) (Mc Nemar test: p=0.008).Using Wilcoxon test we did not find a statisticallysignificant difference in proptosis before and aftertreatment with BTX-A; 21.5±2.7 mm vs 22.0±2.6 mm;(p=0.678).DiscussionIn Graves’ disease increased IOP and proptosis arethe results of orbital tissue infiltration and active extra-ocular muscle contraction13–14.Increased IOP in TAO has been attributed to in-creased episcleral venous pressure resulting from orbitalcongestion and venous outflow obstruction, increased re-sistance of trabecular outflow, restriction and compres-sion of the globe by fibrotic and enlarged rectus muscles,a genetically linked predisposition to glaucoma, or in-creased mucopolysaccharide deposition in the trabecularmeshwork16. In courses of Graves’ ophthalmopathy of re-cent unset, raised muscle tension and reduced elasticityof the affected muscles were caused primarily by activemuscle contraction, not by fibrosis13.Kikkawa and associates reported a significant de-crease in IOP following BTX injections7. The limitationof their study was a small number of patients. In thatstudy only 5 patients were without treatment at thetime of BTX injection. The IOP measurements perfor-med in our study were taken in primary gaze position.We didn’t perform IOP measurements in up gaze posi-tion neither in down gaze position because the aim ofM. Le{in et al.: Botulinum Toxin-A and Thyroid Associated Orbitopathy, Coll. Antropol. 33 (2009) 4: 1155–11571156TABLE 1PATIENTS CHARACTERISTICSCharacteristics Number AgePatientsMale 350.4(3.7)Female 1449.9(6.9)Thyroid statusEuthyroid 2Hyperthyroid 15Smokers 12Duration of Disease 9–15TABLE 2INTRAOCULAR PRESSURE AND HERTELEGZOPHTHALMOMETRY BEFORE AND AFTER BOTULINUMTOXIN-A (BTX-A) INJECTIONBefore BTX-AinjectionAfter BTX-Ainjectionp-value*IOT (mmHg) 18.6±2.8(12–22)16.9±3.3(13–22)0.001Hertel egzophthal-mometry (mm)21.5±2.7(16–24)22.0±2.6(16–25)0.678* Wilcoxon testthe study was to define changes in IOP following BTX-Ainjections, but not to determine ocular hypertension.Ocular hypertension is defined only if IOP is increasedin all positions of gaze. We considered that IOP mea-sured in primary position was sufficient to assess the ef-fect of BTX-A injection on IOP. We speculate that the ef-fect of BTX-A injection into the inferior rectus musclerelieves the muscle contraction and in turn has a lower-ing effect on IOP.To the best of our knowledge this is the first study onthe effect of applied BTX-a injection on proptosis in re-strictive myopathy related to TAO.We didn’t find a significant difference in proptosismeasured by Hertel egzophthalmometry. This could beexplained solely by the effect of BTX-A on extraocularmuscle contraction but not on muscle augmentation.In conclusion, this study clearly demonstrates thatBTX-A injections applied in patients with restrictivemyopathy related to TAO have a lowering effect on IOPbut without influence on proptosis.The limitation of our study was a relatively smallnumber of patients and IOP measurements were notperformed in up gaze position which is probably moresensitive.R E F E R E N C E S1. SUTULA FC, Orbital decompression surgery. In: ALBERT DM (Eds)Ophthalmic surgery: Principles and techniques (Malden MA, BlackwellScience, 1999) — 2. OHTSUKA K, NAKAMURA Y, Am J Ophthalmol,129 (2000) 613. — 3. COCKERHAM KP, PAL C, JANI B, WOLTER A,KENNERDELL JS, Ophthalmology, 104 (1997) 914. — 4. OHTSUKA K,Am J Ophthalmol, 124 (1997) 570. — 5. ALLEN C, STETZ D, ROMANSH, PODOS S, SOM P, DAVIES TF, J Clin Endicrinol Metab, 61 (1985)183. — 6. NORDI M, BARTOLOMEI MP, ROMANI A, BARCA L, GraefesArch Ophthalmol, 226 (1988) 8. — 7. KIKKAWA DO,CRUZ RC, CHRIS-TIAN WK, RIKKERS S, WEINREB RN, LEVI L, GRANET DB, Am JOphthalmol, 135 (2003) 427. — 8. FISHMAN DR, BENES SC, J ClinNeuro-ophthalmol, 11 (1991) 162. — 9. SIMONSZ HJ, VINGERLING JR,Orbit, 17 (1998) 173. — 10. SCOTT AB, Ophthalmology, 87 (1980) 1044.— 11. DUNNWJ, ARNOLD AC, O’CONNOR PS, Ophthalmology, 93 (1986)470. — 12. LYONS CJ, VICKERS SF, LEE JP, Eye, 4 (1990) 538. — 13.STIGLMAYER N, LE[IN M, JURI J, IVANI[EVI] M, BOI] L, ROGO-[I] V, Coll Antropol, 29 (2005) 41. — 14. KALMANN R, MOURITS MP,Br J Ophthalmol, 82 (1998) 754. — 15. KAZIM M, KENNERDELL JS,Orbit, 10 (1991) 211. — 16. DANESH-MAYER HV, SAVINO PJ, DERA-MO V, SERGOTT RC, SMITH AF, Ophthalmology, 108 (2001) 145.M. Le{inEye Department, University Hospital Center Split, 21000 Split, Croatiae-mail: mladen.lesin@st.t-com.hrUTJECAJ LOKALNE PRIMJENE BOTULINUM TOKSINA-A NA INTRAOKULARNI TLAK IPROPTOZU KOD TIROIDNE ORBITOPATIJES A @ E T A KCilj istra`ivanja je bio ispitati utjecaj injekcije Botulinum toksina-A (BTX-A) u podru~je ekstraokularnih mi{i}a naintraokularni tlak (IOP) i proptozu u pacijenata sa poreme}ajima bulbomotorike u tiroidnoj orbitopatiji (TO). InjekcijeBTX-A primjenjene su u 17 pacijenata (20 o~iju) sa restriktivnim strabizmom i dvoslikama. Mjerenje IOT-a aplana-cionom tonometrijom po Goldmannu na~injeno je u primarnom polo`aju oka prije i 2–4 tjedna nakon injekcije BTX-A.Ekstraorbitalna prominencija o~ne jabu~ice mjerena je egzoftalmometrom po Hertelu prije i 2–4 tjedna poslije BTX-Ainjekcije. Srednja vrijednost IOT-a prije injekcije u primarnom polo`aju oka bila je 18,6±2,8 mmHg, a 2–4 tjedna poslijeBTX-A injekcije iznosila je 16,9±3,3 mm Hg; (p=0,001). Nije bilo statisti~ki zna~ajne razlike u vrijednosti egzoftal-mometrije prije i nakon injekcije BTX-A, 21,5±2,7 mm prema 22,0±2,6 mm; (p=0,678). Zaklju~no, injekcija BTX-A imasekundarno djelovanje na sni`enje IOT-a u pacijenata sa TO zbog relaksacije ekstraokularnih mi{i}a, ali bez utjecaja naproptozu.M. Le{in et al.: Botulinum Toxin-A and Thyroid Associated Orbitopathy, Coll. Antropol. 33 (2009) 4: 1155–11571157

Effect of Botulinum Toxin-A Injection on Intraocular Pressure and Proptosis in Thyroid Associated Orbitopathy

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Coll. Antropol. 33 (2009) 4: 1155–1161Original scientific paperEffect of Botulinum Toxin-A Injectionon Intraocular Pressure and Proptosisin Thyroid Associated OrbitopathyMladen Le{in1, Lovro Boji}1, Rinaldo Romac2, Jo{ko Le{in3, Milan Ivani{evi}1, Davor Galetovi}1 andVeljko Rogo{i}11 Eye Department, University Hospital Center Split, Split, Croatia2 Department of Neurology, University Hospital Center Split, Split, Croatia3 Department of Obstetrics and Gynecology, School of Medicine, University of Zagreb, Zagreb, CroatiaA B S T R A C TThe aim of this study was to evaluate the effects of extraocular muscle injection of botulinum toxin-A (BTX-A) onintraocular pressure (IOP) and proptosis in patients with ocular motility disturbances in thyroid associated orbitopathy(TAO). In 17 patients (20 eyes) with restrictive strabismus and diplopia, BTX -A injections were applied. Intraocularpressure was measured with a Goldmann applanation tonometer in primary gaze position before and 2–4 weeks afterBTX-A injection. Extraorbital prominention of the eyeball was measured before and after BTX -A injection using aHertel instrument. Before the injection, the mean IOP in primary position of gaze was 18.6± 2.8 mmHg and 2–4 weeks af-ter BTX-A injection was 16.9±3.3 mmH; (p=0.001). There was no statistically significant difference in Hertel egzoph-thalmometer readings before and after BTX-A injection, 21.5±2.7 mm vs 22.0± 2.6 mm; (p=0.678). In conclusion, BTX-Ainjection has a secondary lowering effect on IOP in TAO due to relaxation of extraocular muscles, but with no influenceon proptosis.Key words: thyroid related orbitopathy, botulinum toxin-A, intraocular pressure, proptosisIntroductionThe thyroid associated orbitopathy (TAO) is charac-terized by proptosis and extraocular muscle involvementwhich can cause restrictive strabismus and increasedintraocular pressure (IOP)1.Causes of elevated IOP inpatients with TAO have been reported to be associatedwith the mechanical effect of extraocular thickening, ele-vated episcleral venus pressure, pressure of swollen or-bital tissues, accumulation of mucopolysaccharide in thetrabecular meshwork and finally coexistent open angleglaucoma2–7.Elevated IOP in up gaze is a common finding and isexplained by a tight inferior rectus muscle that blocksthe episcleral equeous outflow and orbital congestion2,8.It was found that in the Graves disease of recent unset,the raised muscle tension and reduced elasticity of the af-fected muscles, and hence strabismus, were caused pri-marily by active muscle contraction, not by fibrosis9.Treatment with botulinum toxin-A (BTX) in TAO hasbeen shown previously10–13. In a small retrospective se-ries of cases BTX-A caused decreased IOP on restrictivestrabismus associated with thyroid-related orbitopathy7.The aim of this study was to assess the effects ofBTX-A on IOP and proptosis in patients with TAO andrelated restrictive strabismus in observational case-study.Material and MethodsWe retrospectively studied the records of 17 patients(20 eyes, 14 female aged 49.9, range, 40–61 years and 3male aged 50.4, range, 50–57 years, with TAO and re-lated restrictive strabismus or diplopia treated at the De-partment of Ophthalmology University Hospital Splitduring the period from January 2004 to December 2006.Patient data are shown in Table 1.1155Received for publication June 20, 2007Before the therapy two patients were euthyroid andthe others were hyperthyroid. In the time of therapy theywere either euthyroid or with a stable hormonal status ofthe thyroid gland under medication for at least twomonths.Considering the time of initial complaints and theunset of the thyroid gland disease, 5 patients simulta-neously developed symptoms of the thyroid and eye dis-ease. Twelve patients developed eye symptoms after theunset of the thyroid gland disease.There were twelve active smokers. The median timeof duration of the eye signs of TAO was 11 months,ranged 9–15 months.All patients had a history of TAO based on the pres-ence of typical clinical ophthalmic findings (eyelid retrac-tion, limitation of ocular motility, strabismus, proptosisand computed tomography (CT) that revealed evidenceof extraocular muscle enlargement). All the patientswere with active TAO and according to CAS score werewith CAS 4 and more. Seven eyes were with CAS 4 and 5and 13 eyes with CAS 6 and 7.Botulinum toxin-A (Botox-Allergan) is a vial of 100units of the medication in the form of crystal powderwhich is dissolved with 1.0 ml 0.9% solution of natriumchloride so that 0.1 ml of the solution consists 10 IU ofBotulinum toxin A. 0.2 ml (20 IU) were applied with aninsulin syringe under topical anesthesia in the site of theinferior rectus muscle of the affected side.None of the patients was taking antiglaucoma medi-cations, glucocorticoids or was treated with orbital ra-diotherapy; only local supportive lubricants were used.Examination of all patients included in the study wasperformed before and 2–4 weeks after the treatment (vi-sual acuity, inspection of the eyelids and cornea, ocularmotility measurement, Hess-Lancaster test, ophthal-moscopy). Preinjection and postinjection IOP was mea-sured by an unmasked physican using a Goldmannaplanation tonometer in the primary position. Extra-orbital prominention of the eyeball was measured usinga Hertel instrument.Statistical analysis was performed using t-test, c²-test,Mann-Whitney U-test, Wilcoxon test, Mc Nemar test anddescriptive statistics.ResultsIOP and proptosis measured by Hertel egzophthal-mometry taken before and after the injection of BTX-Aare shown in Table 2.Before the injection, the mean IOP was 18.6±2.8 mmHg (range, 12–22 mmHg). After 2–4 weeks followingBTX-A injection, the mean IOP was significantly decrea-sed (16.9±3.3 mmHg, range 13–22 mmHg, p=0.001).Thedecrease in IOP was maintained in seventeen eyes forfour weeks of the observed period of time. In three eyesthe slight increase of IOP (1–3 mm Hg) was noticed twoweeks following BTX-A injection and maintained in theobserved period of four weeks. After BTX-A injection 8 ofthe eyes with CAS 6 and 7 reduced CAS score to 4 and 5(61.5 %) (Mc Nemar test: p=0.008).Using Wilcoxon test we did not find a statisticallysignificant difference in proptosis before and aftertreatment with BTX-A; 21.5±2.7 mm vs 22.0±2.6 mm;(p=0.678).DiscussionIn Graves’ disease increased IOP and proptosis arethe results of orbital tissue infiltration and active extra-ocular muscle contraction13–14.Increased IOP in TAO has been attributed to in-creased episcleral venous pressure resulting from orbitalcongestion and venous outflow obstruction, increased re-sistance of trabecular outflow, restriction and compres-sion of the globe by fibrotic and enlarged rectus muscles,a genetically linked predisposition to glaucoma, or in-creased mucopolysaccharide deposition in the trabecularmeshwork16. In courses of Graves’ ophthalmopathy of re-cent unset, raised muscle tension and reduced elasticityof the affected muscles were caused primarily by activemuscle contraction, not by fibrosis13.Kikkawa and associates reported a significant de-crease in IOP following BTX injections7. The limitationof their study was a small number of patients. In thatstudy only 5 patients were without treatment at thetime of BTX injection. The IOP measurements perfor-med in our study were taken in primary gaze position.We didn’t perform IOP measurements in up gaze posi-tion neither in down gaze position because the aim ofM. Le{in et al.: Botulinum Toxin-A and Thyroid Associated Orbitopathy, Coll. Antropol. 33 (2009) 4: 1155–11571156TABLE 1PATIENTS CHARACTERISTICSCharacteristics Number AgePatientsMale 350.4(3.7)Female 1449.9(6.9)Thyroid statusEuthyroid 2Hyperthyroid 15Smokers 12Duration of Disease 9–15TABLE 2INTRAOCULAR PRESSURE AND HERTELEGZOPHTHALMOMETRY BEFORE AND AFTER BOTULINUMTOXIN-A (BTX-A) INJECTIONBefore BTX-AinjectionAfter BTX-Ainjectionp-value*IOT (mmHg) 18.6±2.8(12–22)16.9±3.3(13–22)0.001Hertel egzophthal-mometry (mm)21.5±2.7(16–24)22.0±2.6(16–25)0.678* Wilcoxon testthe study was to define changes in IOP following BTX-Ainjections, but not to determine ocular hypertension.Ocular hypertension is defined only if IOP is increasedin all positions of gaze. We considered that IOP mea-sured in primary position was sufficient to assess the ef-fect of BTX-A injection on IOP. We speculate that the ef-fect of BTX-A injection into the inferior rectus musclerelieves the muscle contraction and in turn has a lower-ing effect on IOP.To the best of our knowledge this is the first study onthe effect of applied BTX-a injection on proptosis in re-strictive myopathy related to TAO.We didn’t find a significant difference in proptosismeasured by Hertel egzophthalmometry. This could beexplained solely by the effect of BTX-A on extraocularmuscle contraction but not on muscle augmentation.In conclusion, this study clearly demonstrates thatBTX-A injections applied in patients with restrictivemyopathy related to TAO have a lowering effect on IOPbut without influence on proptosis.The limitation of our study was a relatively smallnumber of patients and IOP measurements were notperformed in up gaze position which is probably moresensitive.R E F E R E N C E S1. SUTULA FC, Orbital decompression surgery. In: ALBERT DM (Eds)Ophthalmic surgery: Principles and techniques (Malden MA, BlackwellScience, 1999) — 2. OHTSUKA K, NAKAMURA Y, Am J Ophthalmol,129 (2000) 613. — 3. COCKERHAM KP, PAL C, JANI B, WOLTER A,KENNERDELL JS, Ophthalmology, 104 (1997) 914. — 4. OHTSUKA K,Am J Ophthalmol, 124 (1997) 570. — 5. ALLEN C, STETZ D, ROMANSH, PODOS S, SOM P, DAVIES TF, J Clin Endicrinol Metab, 61 (1985)183. — 6. NORDI M, BARTOLOMEI MP, ROMANI A, BARCA L, GraefesArch Ophthalmol, 226 (1988) 8. — 7. KIKKAWA DO,CRUZ RC, CHRIS-TIAN WK, RIKKERS S, WEINREB RN, LEVI L, GRANET DB, Am JOphthalmol, 135 (2003) 427. — 8. FISHMAN DR, BENES SC, J ClinNeuro-ophthalmol, 11 (1991) 162. — 9. SIMONSZ HJ, VINGERLING JR,Orbit, 17 (1998) 173. — 10. SCOTT AB, Ophthalmology, 87 (1980) 1044.— 11. DUNN WJ, ARNOLD AC, O’CONNOR PS, Ophthalmology, 93 (1986)470. — 12. LYONS CJ, VICKERS SF, LEE JP, Eye, 4 (1990) 538. — 13.STIGLMAYER N, LE[IN M, JURI J, IVANI[EVI] M, BOI] L, ROGO-[I] V, Coll Antropol, 29 (2005) 41. — 14. KALMANN R, MOURITS MP,Br J Ophthalmol, 82 (1998) 754. — 15. KAZIM M, KENNERDELL JS,Orbit, 10 (1991) 211. — 16. DANESH-MAYER HV, SAVINO PJ, DERA-MO V, SERGOTT RC, SMITH AF, Ophthalmology, 108 (2001) 145.M. Le{inEye Department, University Hospital Center Split, 21000 Split, Croatiae-mail: mladen.lesin@st.t-com.hrUTJECAJ LOKALNE PRIMJENE BOTULINUM TOKSINA-A NA INTRAOKULARNI TLAK IPROPTOZU KOD TIROIDNE ORBITOPATIJES A @ E T A KCilj istra`ivanja je bio ispitati utjecaj injekcije Botulinum toksina-A (BTX-A) u podru~je ekstraokularnih mi{i}a naintraokularni tlak (IOP) i proptozu u pacijenata sa poreme}ajima bulbomotorike u tiroidnoj orbitopatiji (TO). InjekcijeBTX-A primjenjene su u 17 pacijenata (20 o~iju) sa restriktivnim strabizmom i dvoslikama. Mjerenje IOT-a aplana-cionom tonometrijom po Goldmannu na~injeno je u primarnom polo`aju oka prije i 2–4 tjedna nakon injekcije BTX-A.Ekstraorbitalna prominencija o~ne jabu~ice mjerena je egzoftalmometrom po Hertelu prije i 2–4 tjedna poslije BTX-Ainjekcije. Srednja vrijednost IOT-a prije injekcije u primarnom polo`aju oka bila je 18,6±2,8 mm Hg, a 2–4 tjedna poslijeBTX-A injekcije iznosila je 16,9±3,3 mm Hg; (p=0,001). Nije bilo statisti~ki zna~ajne razlike u vrijednosti egzoftal-mometrije prije i nakon injekcije BTX-A, 21,5±2,7 mm prema 22,0±2,6 mm; (p=0,678). Zaklju~no, injekcija BTX-A imasekundarno djelovanje na sni`enje IOT-a u pacijenata sa TO zbog relaksacije ekstraokularnih mi{i}a, ali bez utjecaja naproptozu.M. Le{in et al.: Botulinum Toxin-A and Thyroid Associated Orbitopathy, Coll. Antropol. 33 (2009) 4: 1155–11571157

Effect of Botulinum Toxin-A Injection on Intraocular Pressure and Proptosis in Thyroid Associated Orbitopathy

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