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.