In this study, the effectiveness and safety of botulinum toxin (BT) for patients with acute acquired comitant esotropia (AACE) and deviation ≤25PD was investigated with comparison of results to conservative prism therapy. Botulinum toxin was undertaken without electromyographic guidance and with a reduced injection volume of 0.04ml. This was a retrospective study of 60 patients (40 BT and 20 prism therapy). There was no significant difference at baseline for measurements except the BT group had a greater angle at near and distance. In the BT group, diplopia resolved for all patients. At 1 week, the angle of deviation was 3.93 ±2.19PD at distance and 2.48 ±1.70PD at near. Success rate was 57.5% at 6 months. Recurrence occurred in 17 cases (42.5%) at 3–6 months with 3 requiring surgery and 14 having repeat BT. Botulinum toxin complications include 1 with ptosis and 5 with subconjunctival haemorrhage. Those requiring prisms were all corrected but those with significant angles required BT. One case had dizziness with prisms but resolved with angle adjustment. Most could not wean off with prisms. The authors conclude BT offered at lower dose volume was a simple effective treatment for small angle AACE.
Use of reduced volume BT as a treatment option for acute onset comitant esotropia
Reviewed by Fiona Rowe
Botulinum toxin injection with reduced volume in the absence of electromyographic assistance for acute acquired comitant esotropia of 25PD or less.
CONTRIBUTOR
Fiona Rowe (Prof)
Institute of Population Health, University of Liverpool, UK.
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