Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children

Abstract

To determine whether botulinum toxin is as effective as strabismus surgery in the treatment of acute-onset comitant esotropia in children. Retrospective, nonrandomized, comparative clinical study. Setting: Tertiary care pediatric hospital. Forty-nine children with acute-onset comitant esotropia. Treatment with either botulinum toxin ("chemodenervation group") or standard incisional strabismus surgery ("surgery group"). Success rate at 6months (total horizontal deviation of 10 prism diopters or less and evidence of binocular single vision). There were 16 patients in the chemodenervation group and 33 patients in the surgery group. The success rate was not significantly different at 6months (81% vs 61%, P= .20) or at 18months (67% vs 58%, P= .74). The median angle of deviation and median stereoacuity were not significantly different at 6 or 18months. The chemodenervation procedure was not inferior to incisional strabismus surgery at 6months. The duration of general anesthesia (5 vs 71min, P<.001) and time in the post-anesthesia care unit (37 vs 93min, P < .001) were significantly shorter in the chemodenervation group. Botulinum toxin injection payment averaged $874 per procedure compared with $2783 for strabismus surgery. Botulinum toxin is at least as effective as surgery in the treatment of acute-onset comitant esotropia at 6months while reducing the duration of general anesthesia and healthcare costs.