Bupivacaine seen as alternative to strabismus surgery

NASHVILLE, Tenn. — Bupivacaine injection for treatment of the convergence insufficiency type of exotropia may represent a safe, cost-effective alternative to strabismus surgery, according to a speaker.

Reporting 6-month and 5-year outcomes of treatment with 0.75% bupivacaine, Stephen A. Mathias, MD, MPH, told colleagues at the American Association for Pediatric Ophthalmology and Strabismus meeting, “Bupivacaine injection is a simple, in-office procedure with low risk and minimal discomfort to the patient.”

Stephen A. Mathias

Traditional treatment options for the convergence insufficiency type of exotropia, which affects 11% of people with exotropia worldwide, include vision training, prism glasses and muscle shortening surgery. Success rates range widely depending on follow-up duration, and recurrence is expected in the vast majority within 10 to 15 years, he said.

In a retrospective chart review, Mathias and colleagues looked at 124 patients in the 6-month group and 30 patients in the 5-year group and found success in 91% of patients in the 6-month group and 83% in the 5-year group. Success was defined as alleviation of symptoms with or without prism glasses.

In the 5-year group, 17% experienced alleviation of symptoms, 47% required prism glasses, 20% needed a second injection, 13% needed surgery and 10% had new onset strabismus. In the 6-month group, 9% experienced alleviation of symptoms, 14% required prism glasses, 10% needed a second injection, 7% needed surgery and none had new onset strabismus.

Mathias noted, “It is important to remind patients that it is possible to develop another ocular condition that could cause symptoms, even after bupivacaine injection.”

Overall, a 3.11 ∆D change was seen per milliliter bupivacaine injected. In cases of large initial deviations, best results were achieved with a second injection, but with very large initial deviations, 20 ∆D or more, bupivacaine was less successful, Mathias said.

“We also noted a possible wearing-off effect from the injection over the course of several years, and in the literature we find that this is similar to resection for strabismus surgery,” he said. – by Patricia Nale, ELS

Reference:

Mathias SA, Josephson M. Treatment of intermittent exotropia of the convergence insufficiency type with bupivacaine 0.75%: 5-year experience and outcomes. Presented at: American Association for Pediatric Ophthalmology and Strabismus annual meeting; April 2-6, 2017; Nashville, Tenn.

Disclosure: The authors report no relevant financial disclosures.