Long-Term Effect of Botulinum Toxin A in Early and Late Onset Esotropia
Rita Gama, MD; Joana G. Costa, Orthop; Rute S. Costa, Orthop; Catarina Relha, Orthop; Daniela C. Costa, Orthop; Joana C. Santos, Orthop; Tania Y. Nom, Orthop
Hospital da Luz
Introduction: The purposes are: To compare the motor and sensorial results of botulinum toxin A (BTA) treatment in children with infantile esotropia (IET) and acquired nonaccommodative esotropia (ANAET) during the first two years. To evaluate the rate of amblyopia treatment through this period.
Methods: Retrospective study that included 23 children with IET and 25 with ANAET. At 6 months, 1 and 2 years after treatment, the deviation and stereopsis were evaluated. At 2 years, the rate of occlusion or penalization therapy with atropine was determined.
Results: At six months and 1 year after treatment, there were no differences on the rate of orthotropia and stereopsis between the 2 groups. Two years after treatment, orthotropia was achieved by 4 children (21.1%) on IET group and by 15 children (60.0%) on ANAET group, with statistical significance (p=0.007). Four children (21.1%) with IET developed stereopsis and 18 (72.0%) on ANAET group (p=0.004).|After two years, amblyopia treatment was used in 7 patients (36.8%) on IET and in 12 patients (48.0 %) with ANAET.
Discussion: We have demonstrated that the results of BTA treatment are different in different types of esotropia and can change over time. It is a safe procedure and most children don’t need amblyopia treatment after BTA injection.
Conclusion: We recommend BTA as a definite treatment for ANAET but not for IET. The motor and sensorial effects of BTA wear-off after 1 year of treatment for IET. However, most of the patients (IET or ANAET) don’t require amblyopia treatment after BTA.
References: • Thouvenin D, Lesage-Beaudon C, Arné JL. Botulinum toxin injection in infantile strabismus. J Fr Ophthalmol 2008;31:42-50
• Gursoy H et al. Long-term follow-up of bilateral botulinum toxin injections versus bilateral recessions of the medial restus muscles for treatment of infetile esotropia. JAAAPOS 2012;16:269-73
• Biglan AW, Burnstine RA, Rogers GL, Saunders RA. Management of strabismus with botulinum A toxin. Ophthalmology 1989;96:93543
• Rowe FJ, Noonan CP. Botulinum toxin for the treatment of strabismus Cochrane Database syst rev Published Online: 2 MAR 2017