Abstract
Purpose :
For childhood strabismus, early surgical intervention improves both motor and sensory outcomes. Botulinum toxin type A (BTX-A) injection is an alternative to incisional surgery that is fast, less invasive, and preserves a more normal biomechanical construct. This study was undertaken to assess recruitment potential for a randomized controlled trial to assess the safety and effectiveness of BTX-A for horizontal strabismus in children in our institution.
Methods :
Records of all neurologically normal children, less than age 18 years, treated with BTX-A for horizontal strabismus at Beijing Children’s Hospital between March 2018 and September 2019 were reviewed retrospectively. Exclusion criteria included prematurity, developmental delay, other ocular disease, or vertical strabismus. Bilateral injections of BTX-A (Botox; Allergan, 2.5u/0.1ml) were made into the medial or lateral rectus muscles under general anesthesia. Reinjection was permitted if initial alignment was not satisfactory. Patients were followed for 12-18 months after the last injection. Success was defined as any misalignment <10 PD.
Results :
21 patients were included. Mean age at initial treatment was 3.42 ± 2.56 (range from 1-13 years). 13 had esotropia and 8 had exotropia. Mean follow-up was 14.7±1.8 months. Successful alignment was achieved in 14 patients (67%). Esotropia was reduced from 52.7±17.6 PD to 17.7±14.8 PD. Exotropia was reduced from 45.6±11.2 PD to 8.1±11.0 PD. 18 patients received a single injection; 12 of these were successfully aligned. 2 patients had 2 injections and 1 patient had 3 injections. There were no complications.
Conclusions :
Botulinum toxin is an effective treatment for management of horizontal strabismus in children. Additional study of this unique cohort is warranted.
This is a 2020 ARVO Annual Meeting abstract.