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A case of inadvertent intraocular injection of botulinum toxin A for hemifacial spasm Nao Yokotsuka 1 , Mayumi Nagata 1 , Hiroyuki Matsushima 1 , Tadashi Senoo 1 1Department of Ophthalmology, Dokkyo Medical University pp.1103-1108
Published Date 2020/9/15
DOI https://doi.org/10.11477/mf.1410213670
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Abstract Purpose:To report a case of inadvertent intraocular injection of botulinum toxin A(BTX-A)into the vitreous cavity for hemifacial spasm resulting in corneal and lens perforation.

Case:A 71-year-old female underwent BTX-A injections for left hemifacial spasm at a private internal medical clinic and developed ocular perforation. Corrected visual acuity was 0.8 in the left eye. Slit-lamp examination revealed a corneal perforation tear, an anterior capsule crack, and anterior subcapsular cataract in her left eye. Dilated fundus examination could not be performed due to poor transparency. Anterior segment optical coherence tomography(OCT)showed a corneal perforation wound and an anterior capsule crack. Diagnosis of globe perforation and traumatic cataract was made. She underwent phacoemulsification and aspiration for the traumatic cataract caused by BTX-A injection needle to the left eye. Posterior capsule rapture and vitreous opacity floating underneath the rupture area in the vitreous cavity were observed. Pars plana vitrectomy was performed simultaneously. No retinal tear was observed during vitrectomy. In 2 more days, vision in her right eye returned to1.2. Electroretinogram showed intact function in her left eye.

Conclusion:BTX-A injections often have been performed by non-ophthalmologists. This could cause significant complications without appropriate procedure. Intraocular injection of BTX-A was well tolerated, although the needle penetration itself could cause corneal and lens perforation that would need intervention. Appropriate training and procedure may avoid such incidences.


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