The Effect of Different Treatment Methods on Acute Acquired Concomitant Esotropia

Abstract

Objective: The application of botulinum toxin type A (BTXA) in the treatment of paralytic strabismus has been recognized, but there are few studies on the treatment of acute acquired comitant esotropia (AACE). This study was aimed to investigate the clinical characteristics of AACE and compare the therapeutic effects of BTXA and traditional surgery.

Methods: 78 patients with AACE in Renmin Hospital of Wuhan University between March 2019 and March 2021 were reviewed. The relevant medical records of the patients were collected, and they were divided into surgical group (n = 46) and botulinum toxin type A (BTXA) group (n = 32) according to different treatment approaches. The surgical group was treated with squint correction, whereas the BTXA group was treated with microinjection of BTXA in MR. Eye alignment, esotropia, stereopsis, and complications were examined before and after treatment in both groups.

Results: The refractive status of 78 patients with AACE was mostly myopic refractive error. In general, the angle of esotropia at distance was larger than which at near, with a statistically significant difference. At follow-up assessments of 1 week, 1 month, 3 months, and 6 months after treatment, the total effective rates of the surgical group and the BTXA group were 100% and 90.48%, respectively. The residual angle of esotropia of both groups was lower after treatment. Additionally, the incidence rate of complications in the BTXA group was significantly lower than that in the surgical group.

Conclusion: AACE occurs mostly in people with myopic refractive errors and is associated with prolonged near work. Besides surgical treatment, micro-injection of BTXA is also an effective and safe treatment for AACE.

Figure 1

Comparison of deviation before and after treatment in each group. The angle of deviation was measured with the triangular prism and alternate cover tests at 33 cm (near, a) and 6 m (distance, b) fixation. BTXA, botulinum toxin type A. Data was expressed mean ± SD. ∗P < 0.05; ns, no significant difference.