Comparison of the Efficiency of the Botulinum Toxin for the Treatment of Esotropia in Children with and without Neurological Disease and/or Prematurity

Abstract

ABSTRACT Objective To compare the effect of botulinum toxin injection for the management of esotropia in patients with and without neurological disease and/or prematurity. Methods A single-center, retrospective, nonrandomized controlled study was performed on botulinum toxin in 87 children divided into two groups: study group of esotropia in 56 children with neurological disease and/or prematurity and, control group of 31 healthy children with infantile esotropia. All patients were followed for at least 24 months after injection. Success was defined as motor alignment with 10Δ of orthotropia after single bilateral botulinum injection. Results Mean age at treatment was similar in both groups (15.5 vs 14.8 months; p = .555). Mean pretreatment deviation was similar in both groups (50.8Δ vs 50Δ; p = .855). The success rate was better in the control group (61.2% vs 51.7%, p = .265) at 24 months after injection, but the change in the mean angle of deviation was not statistically significant between the groups at 12 and 24 months after injection (p = .264 and p = .547, respectively). Multivariate regression analysis showed that pretreatment angle of deviation and presence of retinopathy of prematurity were significant predictors at 12 months after injection (p = .0001 and p = .004, respectively), while pretreatment angle of deviation was found to be a predictor at 24 months after injection (p = .0001). Conclusions Decreased angle of deviation and absence of retinopathy of prematurity were associated with a better result. There was no difference in motor alignment of esotropia in children with and without neurological disease and/or prematurity. In these patients, botulinum injection may be used as an alternative to surgery.