Botulinum neurotoxin injections in essential infantile esotropia-a comparative study with surgery in large-angle...

Area of Science:

• Ophthalmology
• Pediatric Ophthalmology
• Strabismus Surgery

Background:

• Essential infantile esotropia (IE) is a common condition requiring timely intervention.
• Treatment options include surgical correction and botulinum neurotoxin (BNT) injections.
• Comparing first-line therapies is crucial for optimizing patient outcomes.

Purpose of the Study:

• To compare botulinum neurotoxin (BNT) injections versus surgical intervention as first-line therapy for large-angle essential infantile esotropia (IE).

Main Methods:

• Randomized trial involving children aged 6 months to 6 years with IE of ≥40 prism diopters (PD).
• Interventions included BNT injections or bimedial rectus muscle recession surgery, with BNT augmentation for larger angles (>60 PD).
• Complete response (CR) defined as orthophoria or ≤10 PD misalignment; follow-up at 3, 6, 12, and 24 weeks.

Main Results:

• Surgery achieved a significantly higher proportion of CR compared to BNT injections (OR=4.01).
• Surgical procedures took six times longer than BNT injections.
• In the BNT arm, CR rates were 55.2% for children ≤24 months and 16% for those >24 months.
• For esotropia angles ≤60 PD, CR was 50% with BNT, versus 25% for angles >60 PD.

Conclusions:

• Surgery remains the gold standard for treating essential infantile esotropia.
• Botulinum neurotoxin (BNT) injections are a safe and effective alternative for children ≤24 months and those with smaller esotropia angles (≤60 PD).
• BNT may be particularly valuable in resource-limited settings.