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The purpose of this study was to study the effect of Botulinum Toxin (BT) in refractive and non-refractive accommodative esotropia unresponsive to glasses and poor compliance with glasses. This was a retrospective study of 114 patients who had BT for accommodative esotropia. Twelve were excluded from analysis as they had additional ocular disease. Of 102, 48 were male, 71 were <6 months of age at strabismus onset, 19 had developmental delay or Down’s syndrome and 26 had amblyopia. Average age at BT was 47 months, SD 34.9. Hypermetropia >+2D was present in 32 (refractive cases). The remaining 70 patients were non-refractive with cyclo refraction of <+2D and with high accommodative-convergence over accommodation (AC/A) ratio. Average angle pre injection was 40D and 49.3D for distance and near. At six months post-BT, average angle was 24.5D and 27.66D at distance and near. BT effect was noted by parents at the third to fifth day. Four patients were lost to follow-up at two weeks. Excellent alignment <10PD was achieved by 59 patients, six had small residual angle of 11-20PD, 21 had large residual angles >20PD and 12 were exotropic. Average angle was 11.06PD (exo 10 – eso 70; SD18.52). At six months follow-up, 42 were <10PD, nine with small angle and 41 with large angle esotropia. Average angle was 24.5PD (0-100, SD 23.4). Complications included ptosis (38), exotropia (12) and hypertropia (5) at two weeks post-BT. All resolved by six months. Limitations of this study are its retrospective design, limited binocular assessment and short follow-up period. The authors recommend longer term studies to evaluate outcome-related factors and optimal dose of BT. There were no significant associations found for outcome with age at onset, age at BT, developmental status, amblyopia, refraction and angle of deviation.

Outcomes of pediatric accommodative esotropia with Botulinum Toxin A treatment in Thailand.
Wangtiraumnuay N, Surukrattanaskul S, Surakiatchanukul T, et al.
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Fiona Rowe (Prof)

Institute of Population Health, University of Liverpool, UK.

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