This study presents results of a single-centre institute use of botulinum toxin A (BTA) as an initial treatment choice for acute acquired comitant esotropia (AACE). This was a prospective observational case series study of 72 patients (49 male, 23 female) with mean age of 10.39 ±5.73 years. Seventeen patients were aged ≤5 years, 24 aged 6–10, 14 aged 11–15 and 17 aged >15 years. Sixty-six had no prior or associated illness and MRI was normal. Constant strabismus was noted in 55 patients; intermittent in 17. Mean duration of near device use was 2.92 ±2.25 hours/day before symptom onset. There were 46 emmetropes, 7 myopes and 19 hypermetropies. Mean angle of deviation was 42.57 ±11.16PD at distance and 42.72 ±12.75PD at near. Diplopia was reported by 79% at presentation and 18.6% at 1 week. Transient ptosis and exo deviation resolved by 1-month Limitations of this study were the reduced numbers for follow-up visits and incomplete measures of binocular vision. The authors conclude BTA as an effective first-line treatment option for AACE and reducing the need for strabismus surgery in at least 2-thirds of their patient cohort.
BTA as a first-line treatment option for acute acquired comitant esotropia
Reviewed by Fiona Rowe
An analysis of treatment success of acute acquired comitant esotropia with a single injection of botulinum toxin A: an observation case series study.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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