Long-Term Results of Botulinum Toxin–Augmented Medial Rectus Recessions for Large-Angle Infantile Esotropia

Lueder, Gregg T.; Galli, Marlo; Tychsen, Lawrence; Yıldırım, Cem

doi:10.1016/j.ajo.2011.08.019

Cited by 37 publications

(23 citation statements)

References 20 publications

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“…In addition to, 14 or in place of 15 incisional surgery, the surgeon may inject botulinum toxin into the extraocular muscles. Botulinum injection by itself has been found to produce similar motor and sensory outcomes in children with persistent strabismus following incisional surgery.…”

Section: Introductionmentioning

confidence: 99%

Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children

Leffler

Vaziri

Schwartz

et al. 2016

American Journal of Ophthalmology

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Purpose To determine predictors of reoperation and abnormal binocularity outcomes (including amblyopia and diplopia) following pediatric strabismus surgery. Design Retrospective cross-sectional study. Methods Setting: Review of a national insurance database. Study population: Children under age 18 years having strabismus procedures between 2007 and 2013. Interventions: Adjustable or fixed suture strabismus surgery, or botulinum toxin injection. Outcome measures: Reoperation or diagnosis of abnormal binocularity in the first postoperative year. Results Of 11,115 children having strabismus procedures, 851 (7.7%) underwent reoperation. The reoperation rate was 7.4% for fixed suture surgeries, 9.6% for adjustable suture surgeries (p=0.18), and 44.9% for botulinum injections (p<0.001). Age under 2 years was associated with higher reoperation and abnormal binocularity rates (p<0.001). For horizontal strabismus, the postoperative abnormal binocularity rate was 12.8% for fixed suture surgery and 26.5% for botulinum injection (p=0.005). Reoperation rates tended to be higher with adjustable sutures (odds ratio [OR] 1.69, 95% confidence interval [CI] 0.94 to 3.03, p=0.08), or botulinum toxin injection (OR 10.36, 95% CI 5.75 to 18.66, p<0.001) and lower with 3- or 4-muscle surgery (p=0.001). Esotropia, hyperopia, and botulinum injection were independently associated with higher rates of postoperative abnormal binocularity (p<=0.005). For vertical surgeries, predictors of reoperation were adjustable suture use (OR 2.51, p=0.10) and superior oblique surgery (OR 2.36, p<0.001). Conclusions Adjustable sutures were not associated with a lower reoperation rate in children. Younger age, esotropia, hyperopia, and botulinum injection were associated with postoperative abnormal binocularity. Superior oblique surgery and botulinum injection were associated with higher rates of reoperation.

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Section: Introductionmentioning

confidence: 99%

Rates of Reoperation and Abnormal Binocularity Following Strabismus Surgery in Children

Leffler

Vaziri

Schwartz

et al. 2016

American Journal of Ophthalmology

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“…Of interest, the average number of injections in the successfully treated group was 1.4 and transient ptosis was reported in 32% of the eyes. Lueder et al [20] retrospectively reviewed 23 patients with large angle (greater than 65 prism diopters) infantile esotropia treated with bilateral medial rectus recession augmented with botulinum toxin and had at least 3-year follow up. Their treatment consisted of bilateral medial rectus recession with augmentation of 1.25 units in 1 muscle for patients with 65-70 prism diopters of esotropia and 2.5 units in patients with greater than 70 prism diopters of esotropia.…”

Section: Botulinum Toxin a In Infantile Esotropiamentioning

confidence: 99%

Management of infantile esotropia

Hug

2015

Current Opinion in Ophthalmology

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Although many theories exist, the true cause of infantile esotropia remains unknown. The literature suggests that treatment before age 2 and perhaps even earlier improves the potential for binocular vision. After significant review of literature, it is clear that surgery is the treatment of choice for infantile esotropia but no method has a clear advantage. Efforts to define the best surgical procedure and timing of surgery through prospective, randomized multicenter trials are warranted.

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“…Scott reported an average correction of 65% of the esotropia. Lueder et al (2012) found that successful alignment was achieved in angles greater than 65 Δ by combining botulinum toxin to one or both medial recti with bilateral medial recti recessions at the same time. Campos et al (2000) 88% of 60 infants treated with bilateral medial rectus botulinum toxin before the age of 8 months; all developed a large transient early postinjection exotropia with no long-term consecutive exotropias.…”

Section: Observationmentioning

confidence: 99%