Long-Term Effects of Botulinum Toxin A for Horizontal Concomitant Strabismus in Chinese Children.

Abstract

INTRODUCTION:

For childhood strabismus, early surgical intervention improves both motor and sensory outcomes. Botulinum toxin type A (BTX-A) injection is an alternative to incisional surgery that is fast, less invasive, and preserves a more normal biomechanical construct. This study was undertaken to assess the safety and effectiveness of BTX-A for horizontal concomitant strabismus in children in our institution.

PATIENTS AND METHODS:

Records of all children less than age 18 years with follow-up at least 12 months who were treated with BTX-A for horizontal concomitant strabismus at Beijing Children's Hospital between December 2014 and February 2021 were reviewed retrospectively. Bilateral injections of BTX-A (Henli, 1.25 IU to 5 IU/0.1 ml) were made into the medial or lateral rectus muscles according to the angle of deviation. Reinjection was permitted if the initial alignment was not satisfactory within 1 to 6 months post-injection. Motor success was defined as a final misalignment ≤10 PD. Sensory success was defined as the presence of any evidence of sensory fusion, distance stereopsis, or near stereopsis at the last visit.

RESULTS:

Seventy-one patients were included. Fifty-two had esotropia, and 19 had exotropia. There was a significant decrease in the angle of deviation in all treated patients. The overall motor success rate was 60.6%. The motor success rate was highest in children with esotropia <50 PD (81.5%). Motor success was better for children with partially accommodative esotropia and acquired non-accommodative esotropia (80%, 83.3%, respectively) than for children with infantile esotropia (47.4%). Compared with the esotropia group, the fusion was significantly higher in the exotropia group (p = .007), and the proportion of patients with stereoacuity of better than 100 sec arc was higher also in the exotropia group (71.4%, p = .007), evidence of sensory outcomes were significantly better in the exotropia group. Complications were few. Twenty patients (28.2%) developed transient ptosis after injections; transient vertical deviations were seen in 3 patients (4.2%); and subconjunctival hemorrhage was seen in 5 patients (7%).

CONCLUSIONS:

BTX-A appears to be an effective treatment for the management of horizontal strabismus with motor outcomes best in children with acquired smaller-angle esodeviations. Children with exodeviations had better sensory outcomes in this cohort. A randomized controlled study comparing incisional surgery to BTX-A will be important for guiding future treatment decisions.

• Authors: Jingjing Jiang, Huaxin Zuo, Siyuan Li, Di Cao, Li Li
• Journal: Seminars in ophthalmology (Semin Ophthalmol) Vol. 38 Issue 7 Pg. 638-643 (Oct 2023) ISSN: 1744-5205 [Electronic] England
• PMID: 36914989 (Publication Type: Journal Article)

Chemical References

• Botulinum Toxins, Type A

Topics

• Child
• Humans
• Adolescent
• Botulinum Toxins, Type A (therapeutic use)
• Esotropia (drug therapy, surgery)
• Exotropia (drug therapy, surgery)
• Retrospective Studies
• East Asian People
• Strabismus (drug therapy, surgery)
• Treatment Outcome
• Oculomotor Muscles (surgery)
• Ophthalmologic Surgical Procedures
• Vision, Binocular (physiology)
• Follow-Up Studies