Skip to main content

Advertisement

SpringerLink
Log in

Effects of botulinum a toxin injection on the extraocular muscle fiber layers: Comparison between subtenon injection and intramuscular injection

  • Laboratory Investigation
  • Published:
Japanese Journal of Ophthalmology Aims and scope Submit manuscript

Abstract

Purpose

To compare the morphological changes following injection of botulinum A toxin to the extraocular muscle fiber layers with those following injection to the subtenon intramuscular system.

Methods

Twelve New Zealand white rabbits were divided into two groups. In the first group (six rabbits), four received injections of 10 units of botulinum A toxin into the subtenon space of the superior rectus muscle OD, and the same dose of botulinum A toxin was injected directly into the superior rectus muscle OS. The other two rabbits in the first group were labeled as control animals; 0.1 ml of normal saline was injected into the subtenon space OD, and direct intramuscular injection was performed on the opposite eye. The animals in the first group were killed after 4 weeks to measure the average diameter of the muscle fibers in both the orbital and global layer. In animals of the second group (six rabbits), the same procedures were performed and the animals were killed 12 weeks after treatment.

Results

The average diameter of muscle fibers in both the orbital layer and global layer was markedly reduced in all of the botulinum A toxin-injected groups at 4 weeks after treatment compared with the controls. There was no difference in the average diameter of the muscle fibers between the orbital layer of the subtenon-injected group and that of the intramuscular-injected group at 4 weeks after treatment, but the average diameter of the muscle fibers in the global layer was significantly reduced in the intramuscular-injected group compared with the subtenon-injected group at 4 weeks after treatment. At 12 weeks following treatment, there was no difference in the average diameter between the botulinum A toxin-injected group and the control group regardless of where the toxin was injected.

Conclusion

Subtenon injection of botulinum A toxin induced similar morphological changes as direct intramuscular injection in the extraocular muscle fiber layers. These results suggest the possibility of clinical applications of subtenon botulinum A toxin injection for the treatment of strabismus.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Scott AB, Rosenbaum A, Collins CC. Pharmacologic weakening of extraocular muscles. Invest Ophthalmol Vis Sci 1973;12:924–927.

    CAS  Google Scholar 

  2. Scott AB, Kennedy RA, Stubbs HA. Botulinum A toxin injection as a treatment for blepharospasm. Arch Ophthalmol 1985;103:347–350.

    CAS  PubMed  Google Scholar 

  3. Elston JS, Lee JP, Powell CM, Hogg C, Clark P. Treatment of strabismus in adults with botulinum toxin A. Br J Ophthalmol 1985;69:718–724.

    Article  CAS  PubMed  Google Scholar 

  4. Gammon JA, Gemmill M, Tigges J, Lerman S. Botulinum chemodenervation treatment of strabismus. J Pediatr Ophthalmol Strabismus 1985;22:221–226.

    CAS  PubMed  Google Scholar 

  5. Hoffman RO, Helveston EM. Botulinum in the treatment of adult motility disorders. Int Ophthalmol Clin 1986;26:212–217.

    Article  Google Scholar 

  6. Lee J, Elston J, Vickers S, Powell C, Ketley J, Hogg C. Botulinum toxin therapy for squint. Eye 1988;2:24–28.

    PubMed  Google Scholar 

  7. Melling J, Hambleton P, Shone CC. Clostridium botulinum toxins: nature and preparation for clinical use. Eye 1988;2:16–23.

    PubMed  Google Scholar 

  8. Brin MF. Botulinum toxin: chemistry, pharmacology, toxicity, and immunology. Muscle Nerve Suppl 1997;6:s146–168.

    Article  CAS  PubMed  Google Scholar 

  9. Avila OL, Drachman DB, Pestronk A. Neurotransmission regulates stability of acetylcholine receptors at the neuromuscular junction. J Neuroscience 1989;9:2902–2906.

    CAS  Google Scholar 

  10. Ohtsuki H, Hasebe S, Okano M, Furuse T. Morphological changes in the orbital surface layer muscle of the rabbit eye produced by botulinum toxin. Ophthalmologica 1998;212:53–60.

    Article  CAS  PubMed  Google Scholar 

  11. Kranjc BS, Sketelj J, D’Albis A, Erzen I. Long-term changes in myosin heavy chain composition after botulinum toxin a injection into rat medial rectus muscle. Invest Ophthalmol Vis Sci 2001;42:3158–3164.

    CAS  PubMed  Google Scholar 

  12. Mills MD, Coats DK, Donahue SP, Wheeler DT; American Academy of Ophthalmology. Strabismus surgery for adults: a report by the American Academy of Ophthalmology. Ophthalmology 2004;111:1255–1262.

    Article  PubMed  Google Scholar 

  13. Kao LY, Chao AN. Subtenon injection of botulinum toxin for treatment of sixth nerve palsy. J Pediatr Ophthalmol Strabismus 2003;40:27–30.

    PubMed  Google Scholar 

  14. Ito H, Ito H, Nakano S, Kusaka H. Low-dose subcutaneous injection of botulinum toxin type A for facial synkinesis and hyperlacrimation. Acta Neurol Scand 2007;115:271–274.

    Article  CAS  PubMed  Google Scholar 

  15. Spencer RF, McNeer KW. Botulinum toxin paralysis of adult monkey extraocular muscle. Structural alterations in orbital, singly innervated muscle fibers. Arch Ophthalmol 1987;105:1703–1711.

    CAS  PubMed  Google Scholar 

  16. Humeau Y, Doussau F, Grant NJ, Poulain B. How botulinum and tetanus neurotoxins block neurotransmitter release. Biochimie 2000;82:427–446.

    Article  CAS  PubMed  Google Scholar 

  17. Setler PE. Therapeutic use of botulinum toxins: background and history. Clin J Pain 2002;18:s119–124.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea

    Hae Jung Paik, Jin Seok Choi & Byung Gil Choi

  2. Nuffield Laboratory of Ophthalmology, University of Oxford, Oxford, UK

    Kui Dong Kang

  3. Department of Ophthalmology, Oxford Eye Hospital, Headington, Oxford, UK

    Kui Dong Kang

  4. Department of Ophthalmology, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea

    Hye Bin Yim

  5. Department of Ophthalmology, Our Lady of Mercy Hospital, College of Medicine, The Catholic University of Korea, 665 Bupyongdong, Bupyonggu, Incheon, 403-720, Korea

    Hye Bin Yim

Authors
  1. Hae Jung Paik
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kui Dong Kang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jin Seok Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Byung Gil Choi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Hye Bin Yim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hye Bin Yim.

Additional information

These authors contributed equally to this work.

About this article

Cite this article

Paik, H.J., Kang, K.D., Choi, J.S. et al. Effects of botulinum a toxin injection on the extraocular muscle fiber layers: Comparison between subtenon injection and intramuscular injection. Jpn J Ophthalmol 53, 229–234 (2009). https://doi.org/10.1007/s10384-009-0658-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10384-009-0658-7

Key Words

Search

Navigation