Botulinum toxin type A as treatment of partially accommodative esotropia

Abstract

ObjectiveTo determine the effectiveness of a botulinum toxin type A injection in both medial rectus muscles in patients with partially accommodative esotropia. Residual deviation and stability of strabismus were evaluated at 18 months follow up. MethodA prospective, analytical, quasi-experimental study was conducted on a cohort of 21 patients who underwent total cycloplegic refraction and with a residual deviation of at least 14 DP. A botulinum toxin type A dose of 5IU was injected into each medial rectus muscle for a residual deviation greater than 18 DP, with a dose of 2.5IU being used for a deviation between 14 and 18 DP. Multivariate logistic regression analyses were performed to relate residual deviation to variables recorded as potential predictors. ResultsA total of 21 patients were included, 33.3% (n=7) males and 66.6% (n=14) females. Mean visual acuity was –0.28±0.25 logMAR for right eye (range 0 to –1) and –0.42±0.31 logMAR for left eye (range 0 to –1.3). Mean angle of residual deviation before application of botulinum toxin was 40.95±8.6 DP without spectacles correction, and 22.3±7.99 DP with full cycloplegic refraction. Adverse effects were ptosis in 14.2% (n=3), diplopia 23.8% (n=5), and vertical deviation in 33% (n=7). One patient had a poor outcome, therefore required surgical treatment.At one year follow up, 85.71% of patients showed good results with esotropia of 12 DP or less, dropping to 71.43% at 18 months of follow up. ConclusionBotulinum toxin type A is an effective long-term treatment with a good response in 71.43% of patients. No predictors of good response were demonstrated.