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Botulinum toxin chemodenervation in infants and children: an alternative to incisional strabismus surgery
Insights
Botulinum toxin injections effectively treated horizontal strabismus in 82 children, with 85% needing a second dose. Most experienced temporary side effects like ptosis, but no systemic complications occurred.
Area of Science:
- Ophthalmology
- Pediatric Medicine
- Neurology
Background:
- Horizontal strabismus is a common condition affecting binocular vision in children.
- Botulinum toxin injections offer a minimally invasive treatment option for strabismus.
Purpose of the Study:
- To evaluate the efficacy and safety of botulinum toxin injections for treating horizontal strabismus in pediatric patients.
- To identify potential side effects and the need for repeat treatments.
Main Methods:
- Eighty-two children aged 13 years or younger with horizontal strabismus received botulinum toxin injections.
- Anesthesia varied based on age, with topical drops for younger/older children and ketamine sedation for young children.
- Follow-up assessed treatment success and adverse events.
Main Results:
- Successful improvement in horizontal strabismus was observed in 81 out of 82 patients (98.8%).
- Eighty-five percent of patients required a second injection due to undercorrection.
- Transient side effects, including ptosis and hypertropia, occurred in some patients but resolved within weeks. No systemic complications were reported.
Conclusions:
- Botulinum toxin is a highly effective treatment for horizontal strabismus in children, with a high success rate.
- Repeat injections are frequently necessary, and temporary localized side effects are common but manageable.
- The procedure demonstrates a favorable safety profile in the pediatric population.
Abstract:
Eighty-two children aged 13 years or younger were given injections of botulinum toxin for horizontal strabismus. Improvement was achieved in all but one patient. Children younger than 1 year or older than 6 years of age received only topical drop anesthesia and no sedation. Young children generally required low-dose ketamine sedation. The technique typically undercorrects, so reinjection was necessary in 85% of the patients. There were no systemic complications. Side effects, lasting up to a few weeks, included transient ptosis and hypertropia caused by involvement of other extraocular muscles.