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Long-term results of botulinum toxin-augmented medial rectus recessions for large-angle infantile esotropia
Gregg T Lueder1, Marlo Galli, Lawrence Tychsen
1Department of Ophthalmology, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri 63110, USA. Lueder@vision.wustl.edu
Insights
Botulinum toxin-augmented medial rectus recession effectively treats large-angle infantile esotropia in infants, showing stable long-term results. This surgical approach offers a successful option for managing significant eye deviations.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Strabismus surgery
Background:
- Infantile esotropia is a significant deviation of the eyes present from infancy.
- Large-angle infantile esotropia (> 60 prism diopters) presents a surgical challenge.
- Medial rectus recession is a common surgical technique for esotropia.
Purpose of the Study:
- To evaluate the long-term efficacy of medial rectus recessions combined with botulinum toxin injections.
- To assess the outcomes for infants with large-angle infantile esotropia treated with this augmented surgical approach.
Main Methods:
- An interventional case series was conducted in a hospital-based clinical setting.
- Twenty-three infants with large-angle infantile esotropia underwent bilateral medial rectus recessions augmented with botulinum toxin.
- Patients were followed for a minimum of 2 years postoperatively to assess outcomes.
Main Results:
- The mean age at surgery was 14.5 months, with a mean esotropia angle of 72 prism diopters.
- Seventy-four percent (17 of 23 patients) achieved successful treatment outcomes.
- Successful treatment was defined as no need for further horizontal strabismus surgery and a residual deviation of less than 10 prism diopters.
Conclusions:
- Botulinum toxin-augmented medial rectus recession is an effective treatment for large-angle infantile esotropia.
- The surgical approach demonstrated stable and positive long-term results.
- This method provides a viable option for managing significant infantile esotropia.
Purpose:
To evaluate the long-term results of medial rectus recessions augmented by botulinum toxin injection for treating infants with large-angle (> 60 prism diopters [PD]) infantile esotropia.
Design:
Interventional case series.
Settings:
Hospital-based clinical practice.
Patient Population:
Twenty-three patients with large-angle infantile esotropia who were followed for at least 2 years postoperatively.
Intervention:
Surgical treatment with botulinum toxin in addition to bilateral medial rectus muscle recessions. The preoperative findings, treatment, and outcomes were reviewed.
Main Outcome Measures:
Surgery was considered successful if the patients did not require additional horizontal strabismus surgery and had less than 10 PD of horizontal deviation.
Results:
The age at surgery ranged from 4 to 36 months (mean 14.5 months) and the angle of esotropia ranged from 65 to 100 PD (mean 72 PD). Treatment was successful in 17 of 23 patients (74%), with follow-up of 2 to 13 years (mean 6.6 years).
Conclusion:
Botulinum toxin-augmented medial rectus recession is an effective treatment for large-angle infantile esotropia, with stable results over time.
