Abstract
To study the outcome of botulinum toxin (BTX) treatment (group 1) in partially accommodative esotropia with high accommodative convergence/accommodation (AC/A) ratio, in comparison with bilateral medial rectus muscles recessions and posterior fixation (group 2). In a retrospective comparative study, children aged 3-8 years old treated between 2011 and 2016, with partially accommodative esotropia with high AC/A ratio, deviation at distance of 10 prism diopters or more, and at least 1 year of follow-up, were included. Visual acuity, alternate prism and cover test, stereoacuity, biomicroscopy, and cycloplegic retinoscopy were carried out at initial, baseline visit, 6 months and 1 year after BTX injection or surgery. Main outcome variables were deviation at distance and near, improvement in stereoacuity, and percentage of success. We used multiple regression or proportional odds analysis to control for potential confounding variables. Of 95 patients, 84 were eligible, 48 children in group 1 and 36 in group 2. Deviation and stereoacuity were similar in the two groups at 6 months, but significantly better in the BTX group at 1 year (median distance deviation 0 prism diopters vs 5 prism diopters, p<0.01), although differences were not clinically relevant. Percentage of success was also significantly better only at 1 year (93% vs 72%, p = 0.01). Change in distance-near disparity was not significantly different in the two groups in the period of study. Botulinum toxin could be superior to, or as effective as surgery, at middle term, in the treatment of partially accommodative esotropia with high AC/A ratio.
Highlights
In children with accommodative esotropia type high accommodative convergence/accommodation ratio, correction of hyperopia may control deviation at distance, with persistent deviation at near, but in some patients yet there is residual deviation at distance with glasses on
Deviation and stereoacuity were similar in the two groups at 6 months, but significantly better in the botulinum toxin (BTX) group at 1 year, differences were not clinically relevant
Our purpose was to investigate the results of botulinum toxin (BTX) compared to bilateral medial rectus muscles recessions with posterior fixation in treating partially accommodative esotropia with high AC/A ratio
Summary
In children with accommodative esotropia type high accommodative convergence/accommodation ratio, correction of hyperopia may control deviation at distance, with persistent deviation at near, but in some patients yet there is residual deviation at distance with glasses on (partially accommodative). [2] Another option is to recess medial rectus muscles and add posterior fixation (fadenoperation) to facilitate control of deviation at near.[3,4,5] We had used the latter procedure for several years, whereas botulinum toxin injection in the medial rectus muscles was not considered a primary indication for this condition. Our purpose was to investigate the results of botulinum toxin (BTX) (group 1) compared to bilateral medial rectus muscles recessions with posterior fixation (group 2) in treating partially accommodative esotropia with high AC/A ratio
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