Early retreatment of infantile esotropia: comparison of reoperation and botulinum toxin

Abstract

Aim: To compare the efficacy of reoperation and botulinum toxin injection in treating infantile esotropes early after unsatisfactory surgical alignment.

Methods: 55 strabismic children who had been unsuccessfully operated for infantile esotropia were randomised to reoperation (28 patients) or botulinum toxin injection (27 patients). The motor outcomes (percentage of successful motor outcome and percentage change in deviation) were compared at 6 months, 1 year, and 3 years after retreatment, and the sensory outcomes (percentage with fusion ability and stereo perception) at the 3 year follow up visit.

Results: The motor and sensory outcomes and the stability of motor results were similar in patients reoperated and treated with botulinum injection. At the 3 year visit 67.8% and 59.2% of children were, respectively, within 8 prism dioptres of orthotropia (p=0.72). The frequency of fusion ability was, respectively, 60.7% and 51.8% (p=0.71), and the frequency of stereo perception (</=400 seconds of arc, Randot circles), 57.1% and 48.1% (p=0.70). The botulinum injection was more likely to be effective when carried out in the 6 months following initial surgery.

Conclusions: Botulinum injection is a rapid and less invasive alternative to reoperation in children who have been unsuccessfully treated with surgery to correct infantile esotropia.

Figure 1

Percentages of patients with motor success in the two treatment groups at different moments of the follow up after retreatment (months). Motor success is defined as deviation of 0-8 prism dioptres by the simultaneous prism and cover at 6 metres. The percentages observed are similar in the two groups at 6 months (p=0.72), 1 year (p=0.50), and 3 years (p=0.72). The stability of the motor success rates over the follow up is noticeable.

Figure 2

Percentages of patients with fusion and stereo perception in the two treatment groups. Fusion was acceptable when detected by both the Worth 4 dot at near and the Bagolini lenses. The upper values in the stereopsis bars correspond to the percentages obtained with the Randot circles (at least 400 seconds of arc) and the lower values to those with the TNO test (at least 480 seconds of arc). The difference is not significant in the fusion (p=0.71) and in the stereo perception percentages as measured by the Randot circles (p=0.70) and TNO (p=0.90).