title: Botulinum toxin type A as treatment of partially accommodative esotropia.
abstract: OBJECTIVE
  To determine the effectiveness of a botulinum toxin type A injection in both medial rectus muscles in patients with partially accommodative esotropia. Residual deviation and stability of strabismus were evaluated at 18 months follow up.
  
  
  METHODS
  A prospective, analytical, quasi-experimental study was conducted on a cohort of 21 patients who underwent total cycloplegic refraction and with a residual deviation of at least 14 DP. A botulinum toxin type A dose of 5 IU was injected into each medial rectus muscle for a residual deviation greater than 18 DP, with a dose of 2.5 IU being used for a deviation between 14 and 18 DP. Multivariate logistic regression analyses were performed to relate residual deviation to variables recorded as potential predictors.
  
  
  RESULTS
  A total of 21 patients were included, 33.3% (n=7) males and 66.6% (n=14) females. Mean visual acuity was -.28±.25 logMAR for right eye (range 0 to -1) and -.42±.31 logMAR for left eye (range 0 to -1.3). Mean angle of residual deviation before application of botulinum toxin was 40.95±8.6DP without spectacles correction, and 22.3±7.99 DP with full cycloplegic refraction. Adverse effects were ptosis in 14.2% (n=3), diplopia 23.8% (n=5), and vertical deviation in 33% (n=7). One patient had a poor outcome, therefore required surgical treatment. At one year follow up, 85.71% of patients showed good results with esotropia of 12 DP or less, dropping to 71.43% at 18 months of follow up.
  
  
  CONCLUSIONS
  Botulinum toxin type A is an effective long-term treatment with a good response in 71.43% of patients. No predictors of good response were demonstrated.
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México.
authors.forename: E M
authors.initials: EM
authors.lastname: Flores-Reyes
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México.
authors.forename: M G
authors.initials: MG
authors.lastname: Castillo-López
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México.
authors.forename: R
authors.initials: R
authors.lastname: Toledo-Silva
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México.
authors.forename: J
authors.initials: J
authors.lastname: Vargas-Ortega
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México.
authors.forename: C E
authors.initials: CE
authors.lastname: Murillo-Correa
authors.affiliation: Departamento de Estrabismo, Instituto de Oftalmología Fundación «Conde de Valenciana» IAP, México DF, México. Electronic address: dra.aguilarruiz@yahoo.com.
authors.forename: A
authors.initials: A
authors.lastname: Aguilar-Ruiz
mesh_terms: D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004948:Esotropia / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009801:Oculomotor Muscles; D011446:Prospective Studies; D016896:Treatment Outcome; D014792:Visual Acuity
chemical_list: D001905:Botulinum Toxins; D019274:Botulinum Toxins, Type A
keywords: Ambliopía; Amblyopia; Botulinum toxin type A; Desviación residual; Endotropia parcialmente acomodativa; Estrabismo; Partially accommodative esotropia; Residual deviation; Strabismus; Toxina Botulínica A; Tratamiento; Treatment