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[Value of delayed botulinum toxin injection in esotropia in the child as first line treatment]
P Y Robert1, E Jeaneau-Bellego, P Bertin
1Service d'Ophtalmologie, CHU Dupuytren, Limoges.
Insights
Botulinum toxin injections successfully treated esotropia in children over 3 years old, avoiding surgery in some cases. Success depended on the absence of severe amblyopia and muscle elongation.
Area of Science:
- Ophthalmology
- Pediatric ophthalmology
Context:
- Infantile esotropia is a common condition in children.
- Current treatments often involve surgery.
- Botulinum toxin offers a potential alternative treatment.
Purpose:
- To evaluate the efficacy of botulinum toxin (Botox) injections in treating esotropia in children over 3 years old.
- To assess the outcomes and potential complications of this treatment.
Summary:
- Eight children (aged 3-6 years) with infantile esotropia or decompensated esophoria received bilateral medial rectus injections of botulinum toxin.
- Four children achieved lasting orthotropia, and one showed angle reduction.
- Transient exotropia and ptosis were observed; treatment failed in two amblyopic children.
Impact:
- Botulinum toxin therapy can avoid or limit the need for surgery in pediatric esotropia.
- Success is linked to the absence of deep amblyopia and muscle elongation.
- Limitations include the need for general anesthesia and cost.
Purpose:
Evaluation of botulinum toxin to treat esotropia in children over 3 years old.
Material And Methods:
Eight children (6 boys and 2 girls), aged from 3 to 6 years (mean 4), underwent bilateral injection of 1.25 UI botulinum toxin Botox in medial rectus muscles, under general anesthesia. Preoperative diagnosis was infantile esotropia in 7 cases, and decompensated esophoria in 1 case. Six children had alternating isoacuity before injection, and two had amblyopia. Mean follow-up was 1.8 months (6 to 24 months).
Results:
One transient exotropia, and one transient ptosis were reported. Lasting orthotropia was achieved in four children (including one who presented again spasms in near vision), and lasting angle reduction in another child. Another child had late recurrence at 18 months. The injection was a failure for the two amblyopic children.
Discussion:
Botulinum therapy allowed to avoid surgery in three cases, and to perform a more limited operation in one case.
Conclusion:
Botulinum toxin injection in extraocular muscles is of interest in infantile esotropia as a first treatment, even in children over 3 years. The success relies principally on the absence of deep amblyopia, and muscular elongation troubles. However, the use of botulinum is limited, because it requires general anesthesia, and because of its price.