Conventional surgery versus botulinum toxin injections for partially accommodative esotropia
Sara AlShammari1, Muneeb Alaam2, Shatha Alfreihi3
1College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Canter, Riyadh, Saudi Arabia.
Insights
Bilateral medial rectus recession (BMR) surgery demonstrated a higher success rate for treating partially accommodative esotropia (PAET) compared to botulinum toxin (BTX) injections. BMR also resulted in fewer complications and required shorter follow-up periods.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
- Strabismus surgery
Background:
- Partially accommodative esotropia (PAET) is a common form of strabismus in children.
- Treatment options for PAET include surgical interventions like bilateral medial rectus recession (BMR) and non-surgical approaches.
- Botulinum toxin (BTX) injection has emerged as an alternative treatment modality for various types of strabismus.
Purpose of the Study:
- To compare the efficacy and safety of botulinum toxin (BTX) injection versus bilateral medial rectus recession (BMR) for the treatment of partially accommodative esotropia (PAET).
- To evaluate surgical outcomes, complication rates, and follow-up durations for both treatment modalities in pediatric patients with PAET.
Main Methods:
- Retrospective review of medical records for children aged 1-14 years diagnosed with PAET between 2010 and 2020.
- PAET defined as residual esotropia of at least 14 prism diopters after 6 weeks of full cycloplegic correction (> +2.5 D).
- Success criteria: esotropia of 0-10 prism diopters after a single surgery or ≥1 BTX injections.
Main Results:
- Bilateral medial rectus recession (BMR) achieved a higher success rate (70.9%) compared to botulinum toxin (BTX) injections (53.7%) (P = 0.006).
- BMR was more effective in males, patients over 5 years old, and those with a spherical equivalent ≤ +5.00 D.
- BTX group had a shorter mean surgery duration but longer follow-up, with a higher incidence of postoperative inferior oblique overaction and ptosis; BMR group had a higher rate of consecutive exotropia.
Conclusions:
- Bilateral medial rectus recession (BMR) is a more successful surgical treatment for partially accommodative esotropia (PAET) than botulinum toxin (BTX) injections in the studied cohort.
- Conventional BMR surgery offers advantages of shorter follow-up periods and a lower rate of complications compared to BTX injections for PAET management.
Purpose:
To compare the effect of botulinum toxin injection (BTX) to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET).
Methods:
The medical records of children 1-14 years of age treated for PAET with BMR or BTX between 2010 and 2020 at a single institution were reviewed retrospectively. PAET was defined as residual esotropia of at least 14Δ after 6 weeks of continuous wear of full cycloplegic refraction (> +2.5 D). Success was defined as esotropia of 0Δ-10Δ after a single surgery or ≥1 BTX injections.
Results:
Of 224 patients, 121 received BTX and 103 underwent BMR. BMR showed a higher success rate than BTX (70.9% vs 53.7% [P = 0.006]). BMR was more successful in males, in patients >5 years of age, and when spherical equivalent was ≤ +5.00 D (79.2%, 74.3%, and 67.5%, resp. [P < 0.05]). Mean follow-up was shorter in the BMR group than in the BTX group (16.7 ± 14.7 vs 31.4 ± 29.5 months [P = 0.0001]). Mean duration of surgery was significantly shorter in the BTX group (5.2 ± 4.3 vs 70.5 ± 31.4 min [P = 0.0001]). Postoperative inferior oblique overaction was more common in the BTX group (7.4%; P = 0.02 [Fisher exact test]), and persistent ptosis was only seen in the BTX group (0.8%); consecutive exotropia was only seen in the BMR group (2%).
Conclusions:
In our study cohort, BMR had a higher success rate than BTX. Conventional surgery allowed for shorter follow-up and fewer complications than BTX in the treatment of PAET.
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