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Outcome of Botox Injection in Partially Accommodative Esotropia Compared to Medial Rectus Recession
Ghufran Alarfaj1, Abdulmajeed Alkharashi1, Munirah Z Aldofyan1
1Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
Insights
Bilateral medial rectus recession surgery shows higher initial success for partially accommodative esotropia (PAET) than botulinum toxin (BTX) injections. Repeated BTX treatments achieve similar long-term results, but surgery offers better primary outcomes.
Area of Science:
- Ophthalmology
- Pediatric Ophthalmology
- Strabismus Surgery
Background:
- Partially accommodative esotropia (PAET) is a common form of childhood strabismus.
- Treatment options for PAET include surgical intervention and non-surgical approaches.
Purpose of the Study:
- To compare the effectiveness of botulinum toxin (BTX) injection versus bilateral medial rectus recession (BMR) surgery for treating PAET.
- To evaluate primary and cumulative success rates and complication profiles of both treatment modalities.
Main Methods:
- Retrospective review of 107 children under 15 years old treated for PAET between 2015 and 2022.
- PAET defined as residual esotropia ≥ 14 PD after cycloplegic refraction.
- Primary success: ≤ 10 PD alignment after one treatment; Secondary success: alignment after repeat interventions.
Main Results:
- BMR surgery achieved a higher primary success rate (83.9%) compared to BTX injection (50.9%).
- Cumulative success rates after repeat interventions were comparable: 87.5% for surgery and 78.4% for BTX.
- BTX group had a higher rate of subsequent surgery (11.7%); complication rates were similar (BTX 4.8%, surgery 3.57%).
Conclusions:
- Bilateral medial rectus recession surgery offers superior primary success rates for PAET compared to a single BTX injection.
- Repeated BTX injections can lead to comparable long-term success but may require multiple treatments.
- BTX is less invasive with shorter anesthesia, but potential need for repeat sessions should be discussed.
Purpose:
To compare the effectiveness of botulinum toxin (BTX) injection to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET).
Methods:
This retrospective study reviewed the medical records of 107 children younger than 15 years of age treated for PAET with BTX injection or bilateral medial rectus recession (BMR) surgery at a single institution between 2015 and 2022. PAET was defined as residual esotropia of at least 14 prism diopters (PD) after six weeks of continuous wear of full cycloplegic refraction. Primary success was defined as a distance alignment of ≤ 10 PD after a single treatment (BTX injection or BMR surgery). Secondary success was defined as achieving this alignment after repeated treatment.
Results:
Of 107 patients, 51 received BTX injection and 56 underwent surgery. The surgery group had a significantly higher primary success rate (83.9%) than the BTX injection group (50.9%). No demographic factors correlated with treatment success. After repeat interventions, the cumulative success rate rose to 78.4% in the BTX injection group and 87.5% in the surgery group. Six patients (11.7%) in the BTX injection group eventually required surgical intervention. The complications rate was 4.8% in the BTX injection group (temporary ptosis covering visual axis), and 3.57% in the surgery group (consecutive exotropia necessitating medial rectus advancement).
Conclusion:
Surgical intervention (BMR surgery) demonstrated significantly higher primary success rates for PAET than a single BTX injection. However, repeated BTX injections ultimately achieved comparable long-term success rates. While BTX offers less invasiveness and reduced anesthesia time, the potential need for multiple injections should be considered when counseling patients and their families.
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