The PAUL Glaucoma Implant
edited by Victor Koh Paul Chew Keith Barton
Chapter 15B: Strabismus and glaucoma drainage devices
Janice Lam, Alasdair Kennedy, Saurabh Jain
Botulinum toxin A (BTXA) injection to the lateral rectus muscle in a patient with exotropia in the presence of a glaucoma drainage device (GDD). In this video, the patient is undergoing an injection of BTXA into the lateral rectus (LR) muscle of his right eye under electromyography (EMG) guidance. The needle is inserted just under the lateral canthus and directed as posteriorly into the muscle as possible, to avoid perforating the bleb or interfering with the GDD. The patient is instructed to look towards the right to activate the right LR muscle. When the needle is placed within the LR muscle, a loud signal can be heard through the EMG machine, and this prompts the strabismus surgeon to inject the BTXA into the intended muscle.
