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Management of childhood cyclic esotropia with botulinum toxin
H Yıldırım1, E Sönmezay2, B Tugcu3
1Balıkesir University, Faculty of Medicine, Department of Ophthalmology, Balıkesir, Turkey.
Insights
Botulinum toxin type A (BTA) injections effectively treated childhood cyclic esotropia in three cases, breaking the cycle and achieving long-term orthotropia. Recurrent injections may be needed for residual deviations, establishing BTA as a potential first-line treatment.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Management
Background:
- Childhood cyclic esotropia is a rare condition characterized by recurrent inward turning of the eyes.
- Effective management strategies are crucial for preventing amblyopia and maintaining binocular vision.
Purpose of the Study:
- To describe three cases of childhood cyclic esotropia.
- To evaluate the efficacy of botulinum toxin type A (BTA) treatment in these cases.
Main Methods:
- Three children diagnosed with cyclic esotropia were treated with botulinum toxin type A (BTA) injections.
- BTA (5 IU) was administered into the medial rectus muscles.
Main Results:
- BTA injections successfully broke the esotropic cycle in all three patients.
- Long-term orthotropia was achieved, with follow-up periods ranging from 4 to 8 years.
- One patient required a second BTA injection for residual deviation, while the others achieved stable alignment after the initial treatment.
Conclusions:
- Botulinum toxin type A (BTA) injection is an effective treatment for childhood cyclic esotropia.
- BTA can achieve long-term orthotropia and may be considered a first-line therapy.
- Recurrent BTA injections can be beneficial for managing residual deviations.
Purpose:
We aimed to describe three cases of childhood cyclic esotropia and report the outcomes of botulinum toxin type A (BTA) treatment.
Materials And Methods:
Three children with cyclic esotropia manifesting in a 48-hour cycle were included in the study. BTA (5 IU) was injected into the medial rectus muscles.
Results:
The first patient was a 9-year-old boy with esodeviation (55-50 PD at near and distance) beginning after phacoemulsification surgery for juvenile cataracts. Injection of BTA resulted in breaking the cycle, and a second BTA injection was performed for residual deviation. During the 6-year follow-up, he remained orthophoric with a stereoacuity of 40arcseconds. The second patient was a 9-year-old girl with latent nystagmus and anisometric amblyopia. She experienced diplopia and esotropia (65-45 PD at near and distance). After two BTA injections and 8 years of follow-up, she remained stable with a stereo acuity of 800 arcseconds. The third patient was a 5-year-old boy with a history of falls and right esotropia (40 PD at near and distance). Following a single BTA injection, he was found to be orthophoric with a 4-year follow-up.
Conclusions:
Based on our cases, BTA injection was found to be an effective method for achieving long-term orthotropia. After breaking the cycle with the first BTA injection, recurrent injections may be useful for residual deviations. We believe that BTA injection should be considered the first-line treatment for cyclic esotropia.
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