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Jaime Tejedor, José M. Rodríguez; Long-Term Outcome and Predictor Variables in the Treatment of Acquired Esotropia with Botulinum Toxin. Invest. Ophthalmol. Vis. Sci. 2001;42(11):2542-2546.
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purpose. To determine the long-term results of botulinum therapy in acquired
esotropia and to identify predictors of a satisfactory outcome.
methods. Sixty-eight children (age range, 8–64 months) with acquired esotropia
were enrolled in a prospective study. Botulinum toxin A was injected in
the two medial recti. Motor and sensory statuses were evaluated at 1
and 2 weeks; 3, 6, and 12 months; and every year after the last
injection. Univariate and multivariate logistic regression analyses
were performed to relate motor and sensory outcome to variables
recorded as potential predictors.
results. After an average follow-up of 4.8 years since the last injection, motor
success was obtained in 36 children with one injection (52.9%),
increasing to 48 (70.6%) and 60 (88.2%) children after two and three
injections, respectively. Forty-eight (70.6%) patients had at least
peripheral fusion (category 1 binocularity) and 32 (47.1%) had
stereoacuity of at least 400 seconds of arc (category 2 binocularity).
Higher hypermetropia, less severe amblyopia, and a smaller angle of
esotropia were the best predictors of motor success. Minimal amblyopia
and favorable motor alignment were associated with better binocularity
conclusions. Botulinum is an effective long-term treatment of acquired esotropia. It
is especially useful in children with high hypermetropia, minimal
amblyopia, and small esotropic deviation.
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