The Use of Botulinum Toxin to Treat Infantile Esotropia: A Systematic Review with Meta-Analysis
Dayane C. Issaho, MD; Fabio R. Carvalho, PhD; Marcia K. Tabuse, PhD; Linda C. Carrijo Carvalho, PhD;Denise Freitas, PhD
Federal University of Sao Paulo
Introduction: The purpose of this review was to examine the efficacy of botulinum toxin in the treatment of infantile esotropia and to evaluate the average response of BT and its complication rates.|
Methods: A research was performed in the Latin American and Caribbean Literature on Health Sciences (LILACS), MEDLINE and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched between 28 December 2016 and 30 January 2017. The selection was restricted to articles published in English, Spanish or Portuguese. There were no date restrictions in the search.
Results: Nine studies were eligible for inclusion. The grouped success rate of BT treatment in infantile esotropia was 76% (95% CI = [61% – 89%]). For the success rate, I2 of 94.25% was observed, indicating a high heterogeneity (p <0.001). |The complication rates were also analyzed. The grouped consecutive exotropia (XT) rate was 1% (95% CI = [0% – 2%]). The grouped ptosis rate was 27% (95% CI = [21% – 33%]). The grouped vertical deviation rate was 12% (95% CI = [4% – 22%]).|The mean change of the deviation after BT injection was -30.7 (95% CI = -37.7, -23.8), demonstrating a significant improvement in alignment.|
Discussion: The average change of the deviation after BT injection was -30.7, revealing a significant improvement in alignment after the intervention, although the mean deviation change in the studies was heterogeneous. This supports the indication of BT injection as a good alternative to treat moderate esotropia (until 30-35PD of deviation). |
Conclusion: Botulinum toxin injection into medial recti muscles reveals to be a safe procedure and a valuable alternative to strabismus surgery in congenital esotropia, especially in moderate deviations.|
References: 1. Rowe, Fiona J., and Carmel P. Noonan. Botulinum toxin for the treatment of strabismus. The Cochrane Library (2012).
2. Scott, A. B., Magoon, E. H., McNeer, K. W., & Stager, D. R. (1990). Botulinum treatment of childhood strabismus. Ophthalmology, 97(11), 1434-1438.
3. de Alba Campomanes, A. G., Binenbaum, G., & Eguiarte, G. C. (2010). Comparison of botulinum toxin with surgery as primary treatment for infantile esotropia. Journal of American Association for Pediatric Ophthalmology and Strabismus, 14(2), 111-116.