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G Campomanes, M Acosta, F Zavaleta, D Romero-Apis; Botulinum Toxin In Infantile Esotropia . Invest. Ophthalmol. Vis. Sci. 2002;43(13):1479.
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Purpose:: Demonstrate: if in mid and long term observations good results remain. , and if V patterns , DVD and strabismic amblyopia occurred in the same frequency compared with esotropic patients treated surgically. Methods:: Two hundred and twenty cases with infantile esotropia between 3/12 to 24/12, with any degree of deviation, no accommodative factor, alternating fixation, no A or V patterns or DVD were seen at the Hospital de la Luz between 1996 to 2001. They were trteated with Botox . Five I.U. were used in esotropias up to 15 p.d.. and 7.5 I.U. in esotropias larger than 15 p.d. under sedation. We used one to three applications in both medial recti. . Evaluations were made at 8 days, 1 , 2 3 , 6 months, 1 , 2 , 3 , 4 , 5 years; examination was made searching for the presence of A-V patterns, DVD and amblyopia. We divided the cases into two groups: A) Six to 24/12 of follow-up. B) Two to 5 years of follow-up. Results:: In 220 cases botulinum toxin was applied. The range of age was from 3 to 24 months; In those with less than one year of age in the mid term follow-up 47.5 % orthoposition was obtained. In those between 1 to 2 years of age, in 43.7 % orthoposition was obtained. In accordance to the follow-up two groups were formed: A) One hundred cases with 6 to 24/12 B) One hundred and twenty cases with 2 to 5 years. In 72 %. In 72 % of group A orthoposition was obtained and just in 48.3 % in group B. In 5.3 % of A group A-V patterns were present and in 12.4 % of group B. In 5.3 % of group A DVD was present and in 11.6 % of group B. In 3.4 % of group A alternating fixation was lost, and in 9.6 % in group B. In 29.1 % of all cases, surgical treatment after botox was necessary, but in 75 % of theses cases only two muscles surgery was needed. Conclusion:Good results are obtained in the same proportion at any age More than half of cases require 2 doses and a third of cases 3 doses. Good outcomes diminishes considerably in long term follow-up. Even in cases that need surgery after botox application, less amount of surgery is needed. One fifth of the cases remain with the same degree of deviation after botox application The presence of exotropia with or without adduction limitation observed during the first 2 months post-application give a good prognosis of good outcome A-V patterns, and DVD are observed in a modest percentage of cases, and much less than those cases ssurgically treated. The presence of strabismic amplyopia in 9.6 % in patients that were formerly alternating fixators is an unexplainable finding. Even if surgical treatment in cessesary, less amount of surgery is needed.
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