Early and late effects of botulinum toxin in infantile esotropia

Abstract

AbstractPurposeTo observe the short‐ and long‐term effects of botulinum toxin in infantile esotropia.MethodsBetween February 26th of 2013 and January 27th of 2015, botulinum toxin was injected transconjunctival to bimedial rectus of 5 patients. Following, one patient was checked regularly until their 8th year, one 9th month, one 7th month, one 3rd month, one 1st month. During their regular follow‐up parents were instructed to patch the dominant eye either in consecutive exotropia or esotropia phases. And also, they were assisted on glass prescription. Further, patients were seen again between their 78th and 96th months to find out their current visual acuity and to observe if they had any late term accompanying squints.ResultsBased on our observation derived from the follow‐ups: After the 3rd month on the horizontal plan, orthophoria on 2 patients, monocular esotropia on 2 patients and orthophoria with dissociated horizontal deviation (DHD) developed on 1 patient. On exotropia stage, for 3 hours a day patching was applied on the dominant eye. Inferior oblique muscle hyperfuction (IOHF) developed on all the patients at the earliest 2nd month and at the latest 7.5th year. Dissociated vertical deviation (DVD) and latentnystagmus did not develop on any patient, DHD developed on 1 patient. On the last examination, patients’ visual acuities were determined. On the orthophoric ones who had IOHF development: on his 7.5th year had 1.0/1.0 visual acuity, on her 9th month had 0.4/0.6 visual acuity, and on her 2nd month had 0.2/0.2 visual acuity. In this state, there seems to be an inverse proportion between visual acuity and IOHF development. Monocular esotropia ones: on the strabismic eye 0.1, on the dominant eye full vision was described. These patients were not compliant on their follow‐ups so when IOHF development happened was not determined.ConclusionIt seems botulinum toxin injection gives a chance for restoration of visual immaturity, and by this way infantile esotropia can be made to behave almost similarly to acquired esotropia.