Botulinum Toxin in High AC/A Ratio Accommodative Esotropia
Jaime Tejedor; Francisco J. Gutierrez-Carmona
Hospital Ramon y Cajal
Introduction: Children with high AC/A ratio accommodative esotropia may have deviation at distance and near. We study the results of botulinum toxin (BTX) (group 1) compared to bimedial recession and posterior fixation (group 2) in treating this condition.
Methods: We retrospectively reviewed the charts of children treated for high AC/A ratio accommodative esotropia and deviation of at least 10 PD at distance (2010-2016). Visual acuity, APCT, stereoacuity, biomicroscopy, and cycloplegic retinoscopy were carried out at initial visit, 6 months and 1 year after BTX injection or surgery. We used multiple regression analysis to control for potential confounding variables.
Results: We identified 48 eligible children in group 1 and 36 in group 2 (after 11 and 7 patients were excluded, respectively). Motor and sensory outcomes were similar in the two groups at 6 months, but significantly better in the BTX group at 1 year (4 PD, 95% CI 0 to 8 PD vs 10 PD, 6 to 16 PD p 0.03; 60 arc sec, 40 to 200 arc sec vs 200 arc sec, 100 to 400 arc sec, p 0.02).
Discussion: Motor and sensory results of BTX injection were better than those of bimedial recession and posterior fixation. Due to retrospective design (risk of bias), results should be interpreted with caution.
Conclusion: BTX is better at middle term than bimedial recession and posterior fixation in high AC/A ratio accommodative esotropia with deviation at distance and near, from a motor and sensory point of view.
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