Long-term follow-up of bilateral botulinum toxin injections versus bilateral recessions of the medial rectus muscles for treatment of infantile esotropia.
OBJECTIVE
To compare long-term outcomes of botulinum toxin A injection with incisional surgery for the management of infantile esotropia.


METHODS
Medical records of infants <24 months treated for esotropia with either botulinum toxin injection (botulinum group) or bilateral medial rectus muscle recessions (surgery group) were reviewed. Minimum follow-up was 48 months, and patients with accommodative esotropia or inferior oblique muscle overaction were excluded. Success was defined as alignment with 10(Δ) of orthophoria without surgery (botulinum group) or without reoperation (surgery group) and compared by the use of an adjusted odds ratio (aOR).


RESULTS
The record review identified a total of 51 patients, with 25 in the botulinum group and 26 in the surgery group. Median pretreatment deviation was similar in the botulinum and surgery groups (40(Δ) vs 45(Δ); P = 0.37), but median age at treatment was earlier in the botulinum group (10 vs 12.5 months; P = 0.01). The mean number of injections in successfully treated botulinum group patients was 1.4. The success rate was similar in the botulinum (68%) and surgery (77%) groups (aOR = 0.87, P = 0.87). The median follow-up time was longer in the botulinum group (84 vs 75 months; P = 0.02). Gross stereopsis was demonstrable in 10 of 15 patients in the botulinum group and 9 of 13 in the surgery group (aOR = 3.6, P = 0.46).


CONCLUSIONS
There was no difference in binocular alignment with botulinum toxin versus surgical treatment. Botulinum toxin injection may be considered a primary treatment for infantile esotropia.
Department of Ophthalmology, Eskisehir Osmangazi University, Eskisehir, Turkey.
Huseyin
H
Gursoy
Hikmet
H
Basmak
Afsun
A
Sahin
Nilgun
N
Yildirim
Yasemin
Y
Aydin
Ertugrul
E
Colak
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003867:Depth Perception / Q000502:physiology; D004948:Esotropia / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D007273:Injections, Intramuscular; D009465:Neuromuscular Agents / Q000008:administration & dosage*; D009801:Oculomotor Muscles / Q000187:drug effects* / Q000601:surgery*; D016017:Odds Ratio; D013508:Ophthalmologic Surgical Procedures; D012189:Retrospective Studies; D016896:Treatment Outcome; D015348:Vision, Binocular / Q000502:physiology
D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A