Comparison of Botulinum Toxin With Surgery for the Treatment of Acute-Onset Comitant Esotropia in Children.

PURPOSE

To determine whether botulinum toxin is as effective as strabismus surgery in the treatment of acute-onset comitant esotropia in children.

DESIGN

Retrospective, nonrandomized, comparative clinical study.

METHODS

Setting: Tertiary care pediatric hospital.

STUDY POPULATION

Forty-nine children with acute-onset comitant esotropia.

INTERVENTION

Treatment with either botulinum toxin ("chemodenervation group") or standard incisional strabismus surgery ("surgery group").

MAIN OUTCOME MEASURE

Success rate at 6 months (total horizontal deviation of 10 prism diopters or less and evidence of binocular single vision).

RESULTS

There were 16 patients in the chemodenervation group and 33 patients in the surgery group. The success rate was not significantly different at 6 months (81% vs 61%, P = .20) or at 18 months (67% vs 58%, P = .74). The median angle of deviation and median stereoacuity were not significantly different at 6 or 18 months. The chemodenervation procedure was not inferior to incisional strabismus surgery at 6 months. The duration of general anesthesia (5 vs 71 min, P < .001) and time in the post-anesthesia care unit (37 vs 93 min, P < .001) were significantly shorter in the chemodenervation group. Botulinum toxin injection payment averaged $874 per procedure compared with $2783 for strabismus surgery.

CONCLUSIONS

Botulinum toxin is at least as effective as surgery in the treatment of acute-onset comitant esotropia at 6 months while reducing the duration of general anesthesia and healthcare costs.