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Critical age of botulinum toxin treatment in essential infantile esotropia
E C Campos1, C Schiavi, C Bellusci
1Eye Service, University of Bologna School of Medicine, Italy.
Insights
Botulinum toxin injections effectively treated essential infantile esotropia in children under seven months old. Early treatment achieved good alignment, with long-term stability observed in most cases.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Treatment
Background:
- Essential infantile esotropia is a common form of strabismus in infants.
- Early intervention is crucial for optimal visual development and binocular function.
Purpose of the Study:
- To evaluate the efficacy of botulinum toxin injections for treating essential infantile esotropia.
- To determine the optimal age for botulinum toxin treatment in this population.
Main Methods:
- A single bilateral injection of botulinum toxin into the medial rectus muscles was administered to 60 infants.
- The procedure was performed using an "open sky" technique under direct visualization with general anesthesia.
- Patient age at injection ranged from 5 to 8 months.
Main Results:
- 88% of patients achieved good alignment (within +10 prism diopters) with a mean age of 6.5 months.
- 12% experienced undercorrection or relapse, with a mean age of 7.8 months at injection.
- Alignment remained stable for at least 6 months post-injection; some patients required corrective lenses for hyperopia.
Conclusions:
- Botulinum toxin is an effective treatment for essential infantile esotropia.
- Treatment before 7 months of age is associated with better outcomes.
- Long-term follow-up indicates sustained alignment stability in successfully treated patients.
Purpose:
To assess the results of botulinum toxin treatment in 60 consecutive children with essential infantile esotropia.
Methods:
Bilateral simultaneous injection of botulinum toxin into the medial rectus muscle was performed in 60 patients under direct visualization with an "open sky" technique. Fluothane/sevoflurane insufflation anesthesia was used. Each patient underwent a single bilateral botulinum toxin injection. Patient age at the time of injection ranged from 5-8 months.
Results:
Mean patient age at the time of treatment for the 88% of patients who gained a good alignment (within +10 prism diopters [delta] of residual esotropia) was 6.5 months, while mean patient age at time of injection for the 12% of patients who were undercorrected or the deviation relapsed was 7.8 months. Follow-up averaged 5.2 years (range: 2-9 years, SD 2). No variation of the angle of strabismus was observed after 6 months from injection. In some patients with hyperopic refraction, plus lens corrections were prescribed during follow-up to stabilize the alignment.
Conclusion:
Botulinum toxin can be effective in essential infantile esotropia when children are treated by age 7 months.