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Long-term outcome and predictor variables in the treatment of acquired esotropia with botulinum toxin
1Department of Ophthalmology, Hospital Ramón y Cajal, Madrid, Spain. jtejedor@hrc.insalud.es
Purpose:
To determine the long-term results of botulinum therapy in acquired esotropia and to identify predictors of a satisfactory outcome.
Methods:
Sixty-eight children (age range, 8-64 months) with acquired esotropia were enrolled in a prospective study. Botulinum toxin A was injected in the two medial recti. Motor and sensory statuses were evaluated at 1 and 2 weeks; 3, 6, and 12 months; and every year after the last injection. Univariate and multivariate logistic regression analyses were performed to relate motor and sensory outcome to variables recorded as potential predictors.
Results:
After an average follow-up of 4.8 years since the last injection, motor success was obtained in 36 children with one injection (52.9%), increasing to 48 (70.6%) and 60 (88.2%) children after two and three injections, respectively. Forty-eight (70.6%) patients had at least peripheral fusion (category 1 binocularity) and 32 (47.1%) had stereoacuity of at least 400 seconds of arc (category 2 binocularity). Higher hypermetropia, less severe amblyopia, and a smaller angle of esotropia were the best predictors of motor success. Minimal amblyopia and favorable motor alignment were associated with better binocularity outcome.
Conclusions:
Botulinum is an effective long-term treatment of acquired esotropia. It is especially useful in children with high hypermetropia, minimal amblyopia, and small esotropic deviation.
