Citation: Issaho DC, Carvalho FRS, Tabuse MKU, Carrijo-Carvalho LC, de Freitas D. The use of botulinum toxin to treat infantile esotropia: a systematic review with meta-analysis. Invest Ophthalmol Vis Sci. 2017;58:5468-5476. DOI:10.1167/iovs.17-22576 PURPOSE. The purpose of this review was to examine the efficacy of botulinum toxin in the treatment of infantile esotropia and to evaluate the average response of BT and its complication rates. METHODS. A research was performed in the Latin American and Caribbean Literature on Health Sciences (LILACS), MEDLINE, and Cochrane Central Register of Controlled Trial (CENTRAL).The database was searched between December 28, 2016 and January 30, 2017. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search.RESULTS. Nine studies were eligible for inclusion. The grouped success rate of BT treatment in infantile esotropia was 76% (95% confidence interval [CI]: 61%-89%). For the success rate, I 2 of 94.25% was observed, indicating a high heterogeneity (P < 0.001). The complication rates were also analyzed. The grouped consecutive exotropia (XT) rate was 1% (95% CI: 0%-2%). The grouped ptosis rate was 27% (95% CI: 21%-33%). The grouped vertical deviation rate was 12% (95% CI: 4%-22%). The mean change of the deviation after BT injection was À30.7 (95% CI: À37.7, À23.8), demonstrating a significant improvement in alignment.CONCLUSIONS. Botulinum toxin injection into medial recti muscles reveals to be a safe procedure and a valuable alternative to strabismus surgery in congenital esotropia, especially in moderate deviations.

Surgical success with bilateral medial rectus recessions in infantile esotropia is limited by the high variability in surgical dose-response. [J Pediatr Ophthalmol Strabismus. 2016;53(5):305-310.].

When indicated, patients with intermittent exotropia can be operated upon safely under 4 years of age, and may even present better motor results than older patients. Postoperative stereoacuity in younger children revealed to be worse than in older children; however, this result is unlikely to be due to inadequate age for surgery, but rather, immaturity for performing the stereopsis test.

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This study aimed to analyze the inheritance pattern of infantile esotropia and to investigate the possible involvement of AHI1 gene. Methods:The experimental group consisted of 14 neurologically normal patients with onset of large angle esotropia prior to 6 months of age. Three unaffected subjects from a family of twins with esotropia formed the familial control group. The main control group consisted of 11 organ donors with no history of strabismus. Familial pedigree charts allowed assessing transmission of strabismus phenotype up to four generations. Genomic DNA was obtained from peripheral blood and PCR amplification of AHI1 gene was performed. Results:The mean onset of esotropia was 1.78±2.32 months and the mean deviation was 57±8.5 prims diopters. Amplification of AHI1 was observed in all patients in the control group, but not in those with infantile esotropia. Among the patients evaluated, 57% had a family history of strabismus. Genetic inheritance was observed in two families with monozygotic twins, one of them consisted of monozygotic twins with infantile esotropia and a third dizygotic twin without strabismus. AHI1 did not amplify in the 3 unaffected subjects from the triplets' family that formed the familial control group. Conclusion:The family inheritance of congenital esotropia was verified in the individuals analyzed, with manifestation in the first, second or third generations. In addition, we reported the genetic inheritance in female twins and male triplets, with two univiteline twins presenting esotropia and another dizygotic who did not have strabismus. AHI1 gene may play a role in the pathology of infantile esotropia.

Purpose. The purpose of this review was to compare the efficacy of rectus muscle plication versus resection on the treatment of horizontal strabismus and to evaluate the exodrift after each technique. Methods. A research was performed in Latin American and Caribbean Literature on Health Sciences (LILACS); MEDLINE; and Cochrane Central Register of Controlled Trial (CENTRAL). The database was searched by 30 June 2019. The selection was restricted to articles published in English, Spanish, or Portuguese. There were no date restrictions in the search. A minimum mean follow-up of six months was required to access the primary outcomes. Motor alignment success was defined as postprocedure deviation within 10 prism diopters (PD) of orthotropia. Results. Seven studies were eligible for inclusion. The grouped success rate after plication was 66% (95% CI =  [43%–89%]), and the grouped success rate after resection was 68% (95% CI = [43%–89%]). High heterogeneity was observed between the estimations. There was no difference between the mean amount of deviation corrected in prism diopters, when using the mixed-model approach (SMD = 0.12; 95% CI = −0.2–0.44; p=0.45). The undercorrection rates were also analyzed. The combined odds ratio was 1.37 (95% CI = 0.59–3.16; p=0.462), and there was no statistical significance. Conclusion. Plication of horizontal extraocular muscles reveals to be an alternative to resection in strabismus surgery, with similar results. Exodrift is observed after plication and after resection in the treatment of exotropia, but randomized clinical trials are necessary to analyze and compare the follow-up.

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