Toxina botulínica para el Estrabismo y el Nistagmus.

La toxina botulínica es uno de los fármacos que empleamos en el tratamiento del estrabismo. Este medicamento es una neurotoxina que actúa sobre las terminaciones nerviosas en los músculos, bloqueándolos de manera que lo que produce es una relajación farmacológica del mismo.

La finalidad de este tratamiento es relajar los músculos que producen la desviación del ojo, para que al cabo de unos meses al ir perdiendo efecto, se pueda favorecer la restauración del equilibrio motor y en ocasiones consigamos evitar una intervención más agresiva.

Este tratamiento funciona muy bien en niños muy pequeños (en los primeros años de vida, y mejor en Estrabismos convergentes), y siempre que no haya componentes de desviación vertical o torsional asociados. Así mismo debemos tener en cuenta que a menor grado de desviación, sus resultados son mejores, necesitando en algunas ocasiones cuando hay una gran desviación la repetición del tratamiento para mejorar el resultado.

También puede resultar útil en el diagnóstico y tratamiento de los nistagmus, pues en niños muy pequeños (bebes), puede servir para disminuir temporalmente el movimiento permitiendo un mejor desarrollo visual en esas fases de la vida tan precoces y fundamentales para un correcto desarrollo visual.

También funciona en el caso de los adultos que han tenido un estrabismo reciente secundario a un accidente vascular, facilitando el proceso de recuperación y acelerando el, o en pacientes con estrabismos secundarios a parálisis por diabetes, por ejemplo, donde igualmente puede facilitar la recuperación y acortar el tiempo de visión doble.

El tratamiento con toxina botulínica puede emplearse también en algunos casos muy complejos como método prospectiva para ver el efecto de una supuesta intervención sin necesidad de realizarla, pues paralizando algún músculo podemos ver los resultados de forma temporal. Esto nos permite tener una mayor seguridad a la hora de realizar intervenciones mucho más complejas.

Cuando el tratamiento con toxina botulínica, bien por la edad, por el tipo de estrabismo-nistagmus, o por que sus resultados no han sido los deseados,  la alternativa que nos queda es recurrir a la cirugía clásica sobre los músculos.

El tratamiento con toxina botulínica se realiza mediante una inyección sobre el vientre muscular, por lo cual en los adultos puede realizarse solamente con la ayuda de unas gotas de anestésico, mientras que en los niños requerirá el empleo de anestesia general para poder realizarlo, dado que la colaboración del  niño, más si es muy pequeño, nunca va a ser la adecuada. Normalmente no requiere hospitalización, más alta del tiempo ella intervención y en caso de anestesia general hasta que se encuentre totalmente despierto.

 

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