The use of postoperative botulinum toxin injection in large angle childhood esotropia

Abstract

IntroductionThis study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery.MethodsA retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed.Results3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years).DiscussionThe use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery.ConclusionsBT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime IntroductionThis study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery. This study aimed to assess the influence of preoperative botulinum toxin (BT) injection upon the surgical correction of large angle esotropia (ET) in children and the stability of alignment following subsequent strabismus surgery. MethodsA retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed. A retrospective review of children younger than 14 who had received BT prior to surgery for large angle ET (>50Δ) from January 2002 to April 2012 was undertaken. 27 patients who met inclusion criteria and had been treated with BT to both medial recti were identified. The angles for near and distance fixation, preBT, 3 months post BT, at last follow-up prior to surgery and at last postoperative follow-up were analyzed. Results3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years). 3 months post BT the mean angle of deviation had reduced from 60Δ to 38Δ. This stayed stable (42Δ) after a mean follow-up of 11.8 months. 20 of the 27 patients (74%) had undergone or were awaiting 2-muscle surgery. Of those operated (n = 15), 11 were satisfactorily aligned but 4 exhibited a residual postoperative esotropia of 20Δ or more at final follow-up (range, 3 months to 3 years). DiscussionThe use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery. The use of preoperative BT reduced the angle of deviation in children with large angle ET and enabled the use of less aggressive 2-muscle (instead of 3 or 4 muscle) strabismus surgery. ConclusionsBT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime BT injection prior to planned surgery in large-angle ET is an effective strategy for reducing the angle of esotropia to be surgically managed. We believe this is beneficial for the long term management of these patients who may require further strabismus procedures in their lifetime