97th DOG Annual Meeting 1999
BOTULINUM-TOXIN-A INDUCED TEMPORARY PTOSIS AS A THERAPY MODALITY TO ENHANCE CORNEAL RE-EPITHELIALIZATION
A. Nietgen1, F. Sistani1, J. Rollnick2, R. Winter1
Introduction: As an alternative to a tarsorrhaphie in cases of persistant corneal epithelial defects or ulcers, we induced a temporary ptosis via injection of Botulinum-Toxin-A (BoNT/A).
Mechanism of action: The blockage of the secretion of acetyl choline at the parasympathetic nerve endings leads to a temporary paralysis of the involved muscles. In contrary to the operative mechanical tarsorrhaphie the injection of BoNT/A is easier to perform. We report about our experience after successful application of this method.
Methods an patients: Between 11/98 and 01/99 a temporary paralysis of the m. levator palpebrae was induced by direct intramuscular injection of 15 MU (mouse units) of BoNT/A in three cases. These patients were suffering from therapy-resistant corneal epithelial defects or ulcers.
Results: After 2-3 days the desired protective reversible ptosis could be observed. We could observe a re-epithelialization of corneal surface.
Conclusion: A Botulinum-toxin-A induced temporary ptosis offers an alternative to a tarsorrhaphie. Compared to a tarsorrhaphie following advantages can be observed:
1) Non-invasive method
2) Better follow-up of the cornea due to optimal examination
3) No destruction of the anatomical structures of the lid
4) Optimal application of eye drops
5) Cosmetic advantages
1.Dept. of Ophthalmology, Hannover Medical School, Carl-Neuberg Str. 1, D - 30625 Hannover, Germany.
2.Dept. of Neurology, Hannover Medical School, Carl-Neuberg Str. 1, D - 30625 Hannover, Germany.