Alrasheed Saif Hassan, Challa Naveen Kumar, Aljohani Saeed, Almutairi Nawaf M, Alnawmasi Mohammed M
Department of Optometry, College of Applied Medical Sciences, Qassim University, Buraydah, Saudi Arabia.
PeerJ. 2025 Jun 16;13:e19584. doi: 10.7717/peerj.19584. eCollection 2025.
Esotropia has several types that commonly manifest in early childhood, with numerous treatment options described in the literature. The aim of this systematic review is to synthesize recent research findings on the management of childhood esotropia (ET) to clarify the relative success rates and specific indications for each treatment option, providing guidance for eye care professionals in selecting the most effective interventions.
A comprehensive search was conducted across multiple databases, including PubMed, Web of Science, ProQuest, Scopus, Google Scholar, EBSCO, and Medline, following PRISMA 2020 guidelines. The search was restricted to articles published between 1990 and 2023 that examined various treatment modalities for different types of childhood esotropia (ET). In this study, success was defined as a post-treatment deviation of less than 10 prism dioptres (PD). The study protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42024589042.
The final systematic review included 34 studies from 14 countries, encompassing 3,877 children with a mean age of 4.72 ± 2.08 years. The reviewed studies indicated that optical correction had the highest effectiveness rate at 79.31% after an average follow-up of 5.57 years. Extraocular muscle surgery demonstrated an effectiveness rate of 71.4% with a follow-up period of 2.89 years, while botulinum toxin (BT) injections showed a lower effectiveness rate of 61.24% after a follow-up of 3.15 years.
The review concluded that substantial evidence supports full cycloplegic hyperopic correction as the most effective first-line treatment for childhood accommodative esotropia (AET). However, surgery may be required for some children with AET if their deviation remains over 15 PD after full cycloplegic hyperopic correction. Prismatic correction was highly successful in managing residual deviation in partial AET. Bilateral BT injections proved effective as a first-line treatment for acute-onset ET and infantile ET without a vertical component. Timely surgical intervention enhances sensory outcomes in infantile ET; however, no surgical technique has demonstrated a distinct advantage.
内斜视有多种类型，常见于儿童早期，文献中描述了众多治疗选择。本系统评价的目的是综合近期关于儿童内斜视（ET）治疗的研究结果，以阐明每种治疗选择的相对成功率和具体适应症，为眼科护理专业人员选择最有效的干预措施提供指导。
按照PRISMA 2020指南，在多个数据库中进行全面检索，包括PubMed、科学网、ProQuest、Scopus、谷歌学术、EBSCO和Medline。检索仅限于1990年至2023年发表的研究不同类型儿童内斜视（ET）各种治疗方式的文章。在本研究中，成功定义为治疗后斜视度小于10棱镜度（PD）。该研究方案已在国际前瞻性系统评价注册库（PROSPERO）注册，注册号为CRD42024589042。
最终的系统评价纳入了来自14个国家的34项研究，涉及3877名儿童，平均年龄为4.72±2.08岁。综述研究表明，平均随访5.57年后，光学矫正的有效率最高，为79.31%。眼外肌手术随访2.89年的有效率为71.4%，而肉毒杆菌毒素（BT）注射随访3.15年后的有效率较低，为61.24%。
该综述得出结论，大量证据支持充分的睫状肌麻痹远视矫正作为儿童调节性内斜视（AET）最有效的一线治疗方法。然而，如果一些AET儿童在充分的睫状肌麻痹远视矫正后斜视度仍超过15 PD，则可能需要手术治疗。棱镜矫正在治疗部分AET的残余斜视方面非常成功。双侧BT注射被证明是急性发作性ET和无垂直成分的婴儿型ET的一线有效治疗方法。及时的手术干预可改善婴儿型ET的感觉功能预后；然而，尚无手术技术显示出明显优势。
