This retrospective study reports the results of botulinum toxin A (BTA) augmented bilateral recession or monocular recession / resection (RR) for patients with large angle strabismus. Twenty-four patients were recruited: 10 female, mean age 9.2 ±13.6 years, 20 esotropia and four exotropia. Mean follow-up was 26.7 ±15 months and mean preoperative angle was 61.2 6.8PD for esotropia and 66.2 ±11PD for exotropia. Final mean angle was 6.6 ±9PD for esotropia and 14.5 ±6.4PD for exotropia. A successful outcome, defined as ≤10PD, was 75% for esotropia and 50% for exotropia. For esotropia measuring more than 10PD, two were sensory without fusion, two basic and one infantile. For exotropia measuring more than 10PD, one was infantile and one basic type. The mean additive effect of each 5IU of BTA was 10 ±6PD for esotropia and 9.2 ±6.5 for exotropia. Four had mild ptosis which resolved within one month. There were no complications of vertical strabismus. The authors conclude that augmented surgery with BTA for large angle strabismus is a promising alternative to two stage surgery or three-muscle surgery.
Augmented surgery with BTA for large angle strabismus correction
Reviewed by Fiona Rowe
Botulinum toxin A augmentation of strabismus surgery for large-angle strabismus: a retrospective case series and literature review.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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