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. (C) 2016 Elsevier Inc. All rights reserved.