Comparison of botulinum toxin with surgery for the treatment of acute-onset, comitant esotropia in children

• Published in: American journal of ophthalmology Vol. 176; pp. 33 - 39
• Main Authors: Wan, Michael J, Mantagos, Iason S, Shah, Ankoor S, Kazlas, Melanie, Hunter, David G
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-04-2017; Elsevier Limited
• Subjects: Acute Disease; Biological & chemical weapons; Botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Child; Child, Preschool; Children & youth; Dose-Response Relationship, Drug; Esotropia - physiopathology; Esotropia - therapy; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Medicaid; Neuromuscular Agents - administration & dosage; Oculomotor Muscles - drug effects; Oculomotor Muscles - surgery; Ophthalmologic Surgical Procedures - methods; Ophthalmology; Patients; Pharmaceutical industry; Retrospective Studies; Success; Surgery; Time Factors; Treatment Outcome; Vision, Binocular; Visual Acuity
• ISSN: 0002-9394; 1879-1891
• DOI: 10.1016/j.ajo.2016.12.024

Abstract Purpose To determine whether botulinum toxin is as effective as strabismus surgery in the treatment of acute-onset, comitant esotropia in children. Design Retrospective, non-randomized, comparative clinical study. Methods Setting : Tertiary care pediatric hospital. Study Population : 49 children with acute-onset, comitant esotropia. Intervention Treatment with either botulinum toxin (“chemodenervation group”) or standard incisional strabismus surgery (“surgery group”). Main Outcome Measure Success rate at 6 months (total horizontal deviation of 10 prism diopters or less and evidence of binocular single vision). Results There were 16 patients in the chemodenervation group and 33 patients in the surgery group. The success rate was not significantly different at 6 months (81% versus 61%, p = 0.20) or at 18 months (67% versus 58%, p = 0.74). The median angle of deviation and median stereoacuity were not significantly different at 6 or 18 months. The chemodenervation procedure was not inferior to incisional strabismus surgery at 6 months. The duration of general anesthesia (5 versus 71 min, p < 0.001) and time in the post-anesthesia care unit (37 versus 93 min, p < 0.001) were significantly shorter in the chemodenervation group. Botulinum toxin injection cost an average of $874 per procedure compared to $2,783 for strabismus surgery. Conclusions Botulinum toxin is at least as effective surgery in the treatment of acute-onset, comitant esotropia at 6 months while reducing the duration of general anesthesia and health care costs.