Poster 117

by in  Poster Session 2

 

Role of Botulinum Toxin A in Cyclic Esotropia – A Long Term Follow up

Ayse Ipek Akyuz Unsal, MD1; Seyhan B. Ozkan, MD1; Sule Ziylan, MD2
1Adnan Menderes University Medical School, Department of Ophthalmology, Aydin/ Turkey
2Yeditepe University Medical School, Department of Ophthalmology, Istanbul/ Turkey

 

Introduction: Cyclic strabismus is a rare entity with unknown etiology. The few case reports with the use of Botulinum toxin A (BTXA) did not include the long term outcome. We herein report two cases of childhood cyclic esotropia who underwent BTXA treatment with a follow up at least 8 years in an attempt to demonstrate the long term outcome of BTXA treatment.

Methods: Two cases who presented with sudden onset cyclic esotropia at 2 and 4 years of age were included. BTXA injection was performed into appropriate muscles. Follow up was 8 and 9 years.

Results: Case 1 was a 2 year old boy with left dominant alternating esotropia on a cyclic basis. The squint ranged between 25-45 prism diopters (PD) at near and distance. He underwent BTXA injection into the left medial rectus muscle. He became orthotropic at near and distance with 60 sec arc stereopsis. During the 9 years follow up, he remained stable. Case 2 was a 4 year old girl with the complaint of double vision and squint. Her deviation was 40 PD at near and 35 PD at distance on a cyclic pattern. She underwent bimedial BTXA injection and became orthotropic with glasses. During the 8 years follow up she remained stable with 120 sec arc stereoacuity.

Discussion: Considering the consecutive and recurrent deviations with surgical treatment in previous reports, BTXA seems to be a more appropriate first line option for treatment of cyclic deviations despite the limitations of a non-comparative assumption.

Conclusion: Our results suggest that BTXA is effective to break the cycle permanently in cyclic esotropia.

References:
1.  Lai YH, Fredrick DR. Alteration of cyclic frequency by botulinum toxin injection in adult onset cyclic esotropia. Br J Ophthalmol. 2005;89:1540-1.
2. Sohn MA, Lee TD. A Case of Cyclic Esotropia Cured by Botulinum Toxin Injection. Journal of The Korean Ophthalmological Society. 1999;40:2645-50.
3. Riordan-Eva P, Vickers SF, McCarry B. Cyclic strabismus without binocular function. J Pediatr Ophthalmol Strabismus 1993;30:106-8.
4. Jones A, Jain S. Botulinum toxin: a novel treatment for pediatric cyclic esotropia. J AAPOS. 2014 Dec;18:614-5.
5. Post J, Eidsness R, Romanchuk K. Consecutive exotropia following surgically corrected esotropia. Am Orthoptic J 2007;57:107-10.
6. Cahill M, Walsh J, McAleer A. Reccurence of cyclic esotropia after surgical correction. J AAPOS 1999;3:379-80.

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