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

I Mayet1, N Ally2, H D Alli2

  • 1Department of Ophthalmology, School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa. eyemay.im@gmail.com.

Eye (London, England)
|January 12, 2021
PubMed

Insights

Surgery is more effective for large-angle infantile esotropia, but botulinum neurotoxin (BNT) injections offer a safe alternative for younger children and smaller deviations, especially in resource-limited settings.

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.
Abstract

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