title: Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children.
abstract: OBJECTIVE
  To determine whether botulinum toxin is as effective as strabismus surgery in the treatment of acute-onset comitant esotropia in children.
  
  
  METHODS
  Retrospective, nonrandomized, comparative clinical study.
  
  
  METHODS
  Setting: Tertiary care pediatric hospital.
  
  
  METHODS
  Forty-nine children with acute-onset comitant esotropia.
  
  
  METHODS
  Treatment with either botulinum toxin ("chemodenervation group") or standard incisional strabismus surgery ("surgery group").
  
  
  METHODS
  Success rate at 6 months (total horizontal deviation of 10 prism diopters or less and evidence of binocular single vision).
  
  
  RESULTS
  There were 16 patients in the chemodenervation group and 33 patients in the surgery group. The success rate was not significantly different at 6 months (81% vs 61%, P = .20) or at 18 months (67% vs 58%, P = .74). The median angle of deviation and median stereoacuity were not significantly different at 6 or 18 months. The chemodenervation procedure was not inferior to incisional strabismus surgery at 6 months. The duration of general anesthesia (5 vs 71 min, P < .001) and time in the post-anesthesia care unit (37 vs 93 min, P < .001) were significantly shorter in the chemodenervation group. Botulinum toxin injection payment averaged $874 per procedure compared with $2783 for strabismus surgery.
  
  
  CONCLUSIONS
  Botulinum toxin is at least as effective as surgery in the treatment of acute-onset comitant esotropia at 6 months while reducing the duration of general anesthesia and healthcare costs.
authors.affiliation: Department of Ophthalmology, Harvard Medical School and the Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Wan
authors.affiliation: Department of Ophthalmology, Harvard Medical School and the Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Iason S
authors.initials: IS
authors.lastname: Mantagos
authors.affiliation: Department of Ophthalmology, Harvard Medical School and the Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Ankoor S
authors.initials: AS
authors.lastname: Shah
authors.affiliation: Department of Ophthalmology, Harvard Medical School and the Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Melanie
authors.initials: M
authors.lastname: Kazlas
authors.affiliation: Department of Ophthalmology, Harvard Medical School and the Department of Ophthalmology, Boston Children's Hospital, Boston, Massachusetts. Electronic address: david.hunter@childrens.harvard.edu.
authors.forename: David G
authors.initials: DG
authors.lastname: Hunter
mesh_terms: D000208:Acute Disease; D019274:Botulinum Toxins, Type A / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004948:Esotropia / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D009465:Neuromuscular Agents / Q000008:administration & dosage; D009801:Oculomotor Muscles / Q000187:drug effects / Q000601:surgery*; D013508:Ophthalmologic Surgical Procedures / Q000379:methods*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D015348:Vision, Binocular; D014792:Visual Acuity
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A