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Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia

Alejandra G de Alba Campomanes1, Gil Binenbaum, Glorialicia Campomanes Eguiarte

  • 1Department of Ophthalmology, University of California, San Francisco, San Francisco, CA 94143, USA. dealbaa@vision.ucsf.edu

Journal of AAPOS : the Official Publication of the American Association for Pediatric Ophthalmology and Strabismus
|May 11, 2010
PubMed

Insights

Surgery is more effective than botulinum toxin for large-angle infantile esotropia. Botulinum toxin is a viable alternative for smaller deviations, offering comparable success rates to surgery in these cases.

Area of Science:

  • Ophthalmology
  • Pediatric ophthalmology
  • Strabismus treatment

Background:

  • Infantile esotropia is a common form of strabismus in children.
  • Current treatment options include surgery and, increasingly, botulinum toxin injections.
  • Determining the optimal primary treatment is crucial for effective management.

Purpose of the Study:

  • To compare the efficacy of bilateral medial rectus muscle injection of botulinum toxin versus surgical intervention as primary treatment for infantile esotropia.
  • To evaluate success rates based on the angle of deviation.

Main Methods:

  • A prospective, nonrandomized comparative study involving 442 subjects with infantile esotropia.
  • Children presented by age 36 months with esotropia onset before 12 months.
  • Successful outcome defined as ocular alignment within 10 prism diopters of orthotropia after treatment.

Main Results:

  • Surgery achieved a 66% motor success rate, compared to 45% for botulinum toxin (p < 0.001).
  • For deviations >30 prism diopters, surgery success was 69% vs. 36% for botulinum toxin.
  • For deviations ≤30 prism diopters, success rates were comparable: 60% for surgery and 59% for botulinum toxin.

Conclusions:

  • Surgery is more successful than botulinum toxin for large-angle infantile esotropia (>30-35 prism diopters).
  • Botulinum toxin is effective for small- to moderate-angle infantile esotropia (≤30-35 prism diopters), with success rates comparable to surgery.
  • Botulinum toxin represents a potential alternative primary treatment for smaller deviations.
Abstract

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