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Wang Y, Jiang J, Li L. Long-Term Effects of Botulinum Toxin A Versus Incisional Surgery for Management of Partially Accommodative Esotropia in Children: Comparison of Three Approaches. Am J Ophthalmol 2024; 265:289-295. [PMID: 38789085 DOI: 10.1016/j.ajo.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 04/10/2024] [Accepted: 05/18/2024] [Indexed: 05/26/2024]
Abstract
PURPOSE To compare the effect of bilateral medial rectus injection of botulinum toxin A (BTX-A), bilateral medial rectus muscle recession surgery (BMR rc), or unilateral medial rectus muscle recession combined with lateral rectus muscle resection surgery (R&R), in the management of partially accommodative esotropia (PAET) in children. DESIGN Retrospective comparative clinical study. METHODS The study cohort included 98 patients diagnosed with PAET who had BTX-A injection or incisional surgery between December 2014 and January 2023. The main outcome measures included motor and sensory results as well as complications. Follow-up was at least 12 months for all patients. RESULTS There were 28 patients in the BTX-A group, 45 in the R&R group, and 25 in the BMR rc group. The motor success rates at distance and near fixation respectively were 50% (14/28) and 54% (15/28) in the BTX-A group, which were lower than that of the R&R group (78% [35/45], 84% [38/45]) and the BMR rc group (72% [18/25], 84% [21/25]) (P = .042 for near and P = .006 for distance). For patients with onset age <2.5 years old, there was no statistical difference amongst the 3 surgical approaches (P = .656). For patients with onset age ≥2.5 years, the motor success rate of the R&R group (81% [26/32]) and the BMR rc group (88% [14/16]) was higher than that in the BTX-A group (38% [5/13]; P = .004). There was no statistical difference in sensory outcomes for patients regardless of onset age or treatment methods (P > .05 for all). During follow-up, 4% (2/45) of patients in the R&R group and 20% (5/25) in the BMR rc group developed consecutive exotropia; no patient in the BTX-A group was overcorrected (P = .017). CONCLUSIONS Bilateral medial rectus muscle injection with BTX-A in patients with PAET is a safe, accessible, and low-cost alternative. Although motor success rates were higher, overall, in patients treated with incisional surgery, for patients with earlier age of onset (≤ 2.5 years old), BTX-A injection may be preferred to incisional surgery. In older children treated with unilateral recession-resection surgery, fewer developed consecutive exotropia.
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Affiliation(s)
- Ying Wang
- From the Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Jingjing Jiang
- From the Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Li Li
- From the Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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Bergamim D, Surgik TCDS, Zinher MT, Nogueira de Lassus TC. Botulinum Toxin A Injection in Horizontal Nystagmus: Effect on the Frequency of the Oscillation on a Pediatric Population. J Pediatr Ophthalmol Strabismus 2024:1-6. [PMID: 38815100 DOI: 10.3928/01913913-20240409-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
PURPOSE To evaluate the effect of botulinum toxin A injection on the frequency of horizontal nystagmus in children. METHODS This was a non-randomized before-and-after clinical trial evaluating a cohort of children with horizontal nystagmus before and after treatment with botulinum toxin A. The toxin was injected under general anesthesia with spontaneous ventilation without intubation using the Mendonça forceps and the effect was evaluated by analyzing the frequency of the oscillation in Hertz (Hz) on video registrations before and after treatment. RESULTS The current study found a statistically significant difference on the frequency of the nystagmus in children before and after the injection of botulinum toxin A, with the mean frequency decreasing from 1.55 ± 0.94 Hz before treatment to 1.04 ± 0.87 Hz at 1 month post-injection (P < .001) and to 1.27 ± 0.87 Hz at 6 months post-injection (P = .002). When comparing the data 1 and 6 months post-injection, this study found a significant increase (P = .001) in the frequency of the nystagmus. CONCLUSIONS The injection of botulinum toxin A is effective in reducing the frequency of oscillations in children with horizontal nystagmus both 1 and 6 months after the procedure, and can be used as a first-line, less invasive treatment aiming to decrease the frequency of oscillation. [J Pediatr Ophthalmol Strabismus. 20XX;X(X):XXX-XXX.].
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Jiang J, Zuo H, Li S, Cao D, Li L. Long-Term Effects of Botulinum Toxin A for Horizontal Concomitant Strabismus in Chinese Children. Semin Ophthalmol 2023; 38:638-643. [PMID: 36914989 DOI: 10.1080/08820538.2023.2181666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/26/2023] [Accepted: 01/26/2023] [Indexed: 03/16/2023]
Abstract
INTRODUCTION 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 the safety and effectiveness of BTX-A for horizontal concomitant strabismus in children in our institution. PATIENTS AND METHODS Records of all children less than age 18 years with follow-up at least 12 months who were treated with BTX-A for horizontal concomitant strabismus at Beijing Children's Hospital between December 2014 and February 2021 were reviewed retrospectively. Bilateral injections of BTX-A (Henli, 1.25 IU to 5 IU/0.1 ml) were made into the medial or lateral rectus muscles according to the angle of deviation. Reinjection was permitted if the initial alignment was not satisfactory within 1 to 6 months post-injection. Motor success was defined as a final misalignment ≤10 PD. Sensory success was defined as the presence of any evidence of sensory fusion, distance stereopsis, or near stereopsis at the last visit. RESULTS Seventy-one patients were included. Fifty-two had esotropia, and 19 had exotropia. There was a significant decrease in the angle of deviation in all treated patients. The overall motor success rate was 60.6%. The motor success rate was highest in children with esotropia <50 PD (81.5%). Motor success was better for children with partially accommodative esotropia and acquired non-accommodative esotropia (80%, 83.3%, respectively) than for children with infantile esotropia (47.4%). Compared with the esotropia group, the fusion was significantly higher in the exotropia group (p = .007), and the proportion of patients with stereoacuity of better than 100 sec arc was higher also in the exotropia group (71.4%, p = .007), evidence of sensory outcomes were significantly better in the exotropia group. Complications were few. Twenty patients (28.2%) developed transient ptosis after injections; transient vertical deviations were seen in 3 patients (4.2%); and subconjunctival hemorrhage was seen in 5 patients (7%). CONCLUSIONS BTX-A appears to be an effective treatment for the management of horizontal strabismus with motor outcomes best in children with acquired smaller-angle esodeviations. Children with exodeviations had better sensory outcomes in this cohort. A randomized controlled study comparing incisional surgery to BTX-A will be important for guiding future treatment decisions.
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Affiliation(s)
- Jingjing Jiang
- National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Huaxin Zuo
- National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Siyuan Li
- National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Di Cao
- National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Li
- National Center for Children's Health, MOE Key Laboratory of Major Diseases in Children, Department of Ophthalmology, Beijing Children's Hospital, Capital Medical University, Beijing, China
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AlShamlan FT, Alghazal F. Comparison of Dose Increments of Botulinum Toxin A with Surgery as Primary Treatment for Infantile Esotropia and Partially Accommodative Esotropia. Clin Ophthalmol 2022; 16:2843-2849. [PMID: 36061630 PMCID: PMC9432566 DOI: 10.2147/opth.s382499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/23/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To compare the effect of increment dose of botulinum toxin (BTX) injection in correlation to the angle of deviation to bilateral medial rectus recession (BMR) in infantile esotropia and partially accommodative esotropia (PAET). Methods This was a retrospective study that included pediatric patients ≤16 years old with infantile esotropia and PAET at Dhahran Eye Specialist Hospital (DESH) from 2014 till 2021 treated with increment dose of BTX or BMR. A successful outcome is defined as ocular alignment within 10 PD of deviation after 1–3 BTX injections or one surgery with a minimum follow-up of 6 months. Results Of 177 patients, 101 patients received BTX treatment for either infantile esotropia (n = 37) or PAET (n = 64) and 76 patients underwent BMR for either infantile ET (n = 25) or PAET (n = 51). BTX showed a higher success rate than BMR {65.3% vs 55.3% (p = 0.174)}. In patients with infantile esotropia, the success rate was comparable between BTX group and BMR group {40.5% vs 52% (p = 0.440)}. However, the success rate was statistically significantly higher in BTX group in compare to BMR group {79.7% vs 56.9% (p = 0.014)}. Consecutive exotropia was 0% in BTX group and 9.2% in BMR group (p = 0.002). Conclusion The increment dose of BTX injection is comparable to surgery in patients with infantile esotropia but superior to the routine surgery in patients with PAET. BTX has the advantage of a shorter procedure duration, lower costs, less exposure to general anesthesia and being minimally invasive intervention.
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Affiliation(s)
- Fatemah T AlShamlan
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
- Correspondence: Fatemah T AlShamlan, Email
| | - Fatimah Alghazal
- Pediatric Ophthalmology and Strabismus Department, Dhahran Eye Specialist Hospital, Dhahran, Saudi Arabia
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Alarfaj MA, Alsarhani WK, Alrashed SH, Alarfaj FA, Ahmad K, Awad A, Sesma G. Factors Affecting the Efficacy of Botulinum Toxin Injection in the Treatment of Infantile and Partially Accommodative Esotropia. Middle East Afr J Ophthalmol 2022; 29:122-126. [PMID: 37408716 PMCID: PMC10319075 DOI: 10.4103/meajo.meajo_39_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/29/2023] [Accepted: 04/25/2023] [Indexed: 07/07/2023] Open
Abstract
PURPOSE We aimed to investigate the effect of botulinum toxin (BT) injection on the treatment of infantile and partially accommodative esotropia (PAET). METHODS This retrospective cohort study included patients who received BT injections for infantile and PAET between January 2015 and December 2018. Treatment was considered successful if orthotropia, consecutive exotropia, or esotropia within 10 prism diopters (PD) was achieved. RESULTS The overall success rate was 47.4%, with a mean follow-up period of 27.8 months in 403 children. BT treatment was considered successful in 37.1% of cases of infantile esotropia and 53.1% of cases of partially accommodative esotropia. The average deviation angle before starting treatment was 35.5 ± 13.9 PD. Side effects 1 week after BT injections included transient overcorrection (63.8%) and transient ptosis (41.7%). There were no significant differences in the success rates between the different doses of BT (P = 0.69). The angle of deviation at presentation was significantly associated with the success rate of BT injection (failed group, mean: 38.1 ± 15.3 PD vs. success group, mean: 32.6 ± 11.6 PD; P < 0.001). Other factors associated with higher success rates were overcorrection at 1 week and PAET, while multivariate logistic regression analysis showed that a smaller angle of deviation and overcorrection (1 week after injection) were associated with a higher success rate. CONCLUSION A smaller angle of deviation and transient overcorrection were associated with a higher success rate, and no significant difference was observed in the success rates of different BT doses.
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Affiliation(s)
- Motazz A. Alarfaj
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
- Department of Ophthalmology, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed K. Alsarhani
- Department of Ophthalmology, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Saleh H. Alrashed
- Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Faris A. Alarfaj
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Khabir Ahmad
- Department of Research, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Abdulaziz Awad
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
| | - Gorka Sesma
- Pediatric Ophthalmology and Strabismus Division, King Khaled Eye Specialist Hospital, Riyadh, Saudi Arabia
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Response to botulinum neurotoxin injections in large-angle infantile esotropia: a post hoc analysis. J AAPOS 2022; 26:79.e1-79.e5. [PMID: 35318152 DOI: 10.1016/j.jaapos.2021.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 11/03/2021] [Accepted: 11/07/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the anticipated reduction of baseline angle of esotropia and identify predictors of change following botulinum neurotoxin (BNT) injections in large-angle infantile esotropia. METHODS This was a prospective, longitudinal study of children <10 years of age diagnosed with infantile esotropia of >30Δ and given either 1, 2, or 3 BNT injections. Post-injection change from baseline deviation was recorded, and predictors of reduction were analyzed. For this study, children were further divided into subgroups based on initial deviation of ≤60Δ (group 1) and >60Δ (group 2). The outcomes of subsequent surgeries in failed cases were analyzed. RESULTS A total of 117 children were included, 55 in group 1 and 62 in group 2. Mean age was 30.3 ± 18.8 months. Mean baseline deviation was 62.5Δ ± 13.1Δ: 51.4Δ ± 8.4Δ in group 1 and 73Δ ± 7.5Δ in group 2. The mean number of injections was 2.2 ± 0.7. Success was achieved in 25.6% of patients (33.4% in group 1; 16.2% in group 2). The mean percentage reduction of deviation after BNT injection was 55.2% ± 26%, larger in group 1 than in group 2 (61.3% vs 51.1% [P = 0.001]). Five children reverted to baseline deviation. In multivariate analysis, adjusting for number of injections, younger age and larger baseline deviation were significant independent predictors of a larger absolute amount of reduction (P = 0.02, and 0.002, resp.). Thirty-two children had subsequent surgery; 22 were followed for a minimum of 6 months, and 20 were aligned within 10Δ of orthotropia. CONCLUSIONS In large-angle esotropia there was a reduction of approximately 50% of baseline deviation, with greater relative reduction for smaller baseline deviations; the absolute change in angle was greater in younger children. Alignment after subsequent surgery appeared to remain stable and surgery required less recession than would have been needed for the original angle of esotropia.
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Fu JJ, Hsieh MW, Lee LC, Chen PL, Wen LY, Chen YH, Chien KH. A Novel Method Ensuring an Immediate Target Angle After Horizontal Strabismus Surgery in Children. Front Med (Lausanne) 2022; 9:791068. [PMID: 35280861 PMCID: PMC8907740 DOI: 10.3389/fmed.2022.791068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 01/28/2022] [Indexed: 12/05/2022] Open
Abstract
Purpose Pediatric strabismus surgery has low success rates and high reoperation rates because of difficult alignment measurements and the nature of different strabismus types. Furthermore, adjustable sutures are not easily employed in children on an OPD basis. Methods This was a retrospective comparative case study of children less than 12 years old who underwent strabismus surgery and were followed up at least 6 months postoperatively. We proposed a novel method that combines adjustable sutures and corneal light reflexes in regular strabismus surgery to improve surgical results. Efficacy and safety were evaluated and compared with those in a regular fixed-suture group. Results In total, 128 children (88: exotropia and 41: esotropia) in the novel method group (Group 1) and 109 (71: exotropia and 38: esotropia) in the regular fixed-suture group (Group 2) were enrolled. The primary outcome was the immediate target angle (for esotropia within 4 PD of orthotropia and exotropia within 8 PD of esotropia within the first week postoperatively); the secondary outcome was success at the 6-month visit (angle of deviation < 10 PD). Consequently, there was a significantly higher proportion of achieving the immediate target range and success rate in both exotropic and esotropic patients in Group 1 than in Group 2. A significantly lower reoperation rate was also demonstrated in Group 1. No complications were noted in either group. Conclusions: The novel method enabled a higher proportion of subjects to achieve an immediate target range and success rate and a lower chance of reoperation among both esotropic and exotropic patients.
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Affiliation(s)
| | - Meng-Wei Hsieh
- Department of Ophthalmology, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Lung-Chi Lee
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | | | - Liang-Yen Wen
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
| | - Ke-Hung Chien
- Department of Ophthalmology, Tri-Service General Hospital and National Defense Medical Center, Taipei, Taiwan
- *Correspondence: Ke-Hung Chien
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AlShammari S, Alaam M, Alfreihi S. Conventional surgery versus botulinum toxin injections for partially accommodative esotropia. J AAPOS 2022; 26:16.e1-16.e6. [PMID: 35017084 DOI: 10.1016/j.jaapos.2021.08.308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/31/2021] [Accepted: 08/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the effect of botulinum toxin injection (BTX) to bilateral medial rectus recession (BMR) in partially accommodative esotropia (PAET). METHODS The medical records of children 1-14 years of age treated for PAET with BMR or BTX between 2010 and 2020 at a single institution were reviewed retrospectively. PAET was defined as residual esotropia of at least 14Δ after 6 weeks of continuous wear of full cycloplegic refraction (> +2.5 D). Success was defined as esotropia of 0Δ-10Δ after a single surgery or ≥1 BTX injections. RESULTS Of 224 patients, 121 received BTX and 103 underwent BMR. BMR showed a higher success rate than BTX (70.9% vs 53.7% [P = 0.006]). BMR was more successful in males, in patients >5 years of age, and when spherical equivalent was ≤ +5.00 D (79.2%, 74.3%, and 67.5%, resp. [P < 0.05]). Mean follow-up was shorter in the BMR group than in the BTX group (16.7 ± 14.7 vs 31.4 ± 29.5 months [P = 0.0001]). Mean duration of surgery was significantly shorter in the BTX group (5.2 ± 4.3 vs 70.5 ± 31.4 min [P = 0.0001]). Postoperative inferior oblique overaction was more common in the BTX group (7.4%; P = 0.02 [Fisher exact test]), and persistent ptosis was only seen in the BTX group (0.8%); consecutive exotropia was only seen in the BMR group (2%). CONCLUSIONS In our study cohort, BMR had a higher success rate than BTX. Conventional surgery allowed for shorter follow-up and fewer complications than BTX in the treatment of PAET.
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Affiliation(s)
- Sara AlShammari
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Canter, Riyadh, Saudi Arabia
| | - Muneeb Alaam
- Pediatric Ophthalmology Division, Pediatric Surgery Department, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia
| | - Shatha Alfreihi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Canter, Riyadh, Saudi Arabia; Pediatric Ophthalmology Division, Pediatric Surgery Department, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia.
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