Abstract
Purpose :
Cyclic esotropia is a rare phenomenon, occurring in one case per 3,000 to 5,000 patients with strabismus. The most common operation reported in the treatment of cyclic esotropia is a bilateral medial rectus recession, however some have reported a unilateral recession-resection while others have employed botulinum toxin injections to the bilateral medial rectus muscles. The purpose of this study is to describe the clinical course and surgical treatment of children with cyclic esotropia.
Methods :
The clinical course of four children with cyclic esotropia presenting at the University of California San Francisco were retrospectively reviewed (April 2015 to August 2019). Two children underwent bilateral medical rectus recession (BMRc), one child underwent a right medial rectus recession and right lateral rectus resection (right R&R), and one child underwent botulinum toxin injections to each medial rectus muscle. The surgical correction was based on the largest manifest deviation on an esotropic day.
Results :
All patients were orthotropic and exhibited stereopsis at the postoperatve week two appointment. Both patients that underwent BMRc remained orthotropic at one month and nine months postoperatively. The patient who underwent a right R&R remained orthotropic one month postoperatively and then was lost to follow-up. The patient who underwent bilateral medial rectus botulinum toxin injections was found to have a unilateral ptosis and 8 prism diopter exophoria at the postoperative week two appointment, which resolved by postoperative month four.
Conclusions :
Strabismus surgery and bilateral botulinum toxin injections based on the largest manifest deviation on an esotropic day are associated with excellent surgical outcomes in children with cyclic esotropia. Both surgical approaches of BMRc and unilateral R&R along with botulinum toxin injections to the bilateral medial rectus muscles provided excellent surgical results and reestablished stereopsis in these children. Patients that undergo botulinum toxin injection may be more likely to experience a transient ptosis postoperatively. Surgeons may consider either a bilateral medical rectus recession, unilateral recession-resection, or bilateral medial rectus botulinum toxin injections aimed at the largest manifest esodeviation when treating cyclic esotropia in children.
This is a 2020 ARVO Annual Meeting abstract.