A Comparison of Chemodnervation to Incisional Surgery for Acute, Acquired, Comitant Esotropia: An International Study.

Autor: Cheung CSY; From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA; Department of Ophthalmology and Vision Science (C.C, M.W), University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada., Wan MJ; Department of Ophthalmology and Vision Science (C.C, M.W), University of Toronto and Hospital for Sick Children, Toronto, Ontario, Canada., Zurakowski D; Departments of Anesthesiology and Surgery, Boston Children's Hospital (D.Z), Harvard Medical School, Boston, Massachusetts, USA., Kodsi S; Department of Ophthalmology (S.K), Northwell Health, Great Neck, New York, USA., Ekdawi NS; Department of Ophthalmology (N.E), Wheaton Eye Clinic, Wheaton, Illinois, USA., Russell HC; Faculty of Health Sciences & Medicine, Bond University and Department of Ophthalmology (H.R), Gold Coast University Hospital, Gold Coast, Australia., Shetty S; Paediatric Ophthalmology (S.S), Aravind Eye Hospital, Madurai, Tamil Nadu, India., Dumitrescu AV; Department of Ophthalmology (A.D), University of Iowa, Iowa City, Iowa, USA., Dagi LR; From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA., Shah AS; From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA., Hunter DG; From the Department of Ophthalmology (C.C, L.D, A.S, D.H), Harvard Medical School and Boston Children's Hospital, Boston, Massachusetts, USA. Electronic address: david.hunter@childrens.harvard.edu.
Jazyk: angličtina
Zdroj: American journal of ophthalmology [Am J Ophthalmol] 2024 Jul; Vol. 263, pp. 160-167. Date of Electronic Publication: 2024 Mar 04.
DOI: 10.1016/j.ajo.2024.02.036
Abstrakt: Purpose: To compare the efficacy of botulinum toxin injections to strabismus surgery in children with acute, acquired, comitant esotropia (ACE), and to investigate factors predicting success.
Design: International, multi-center nonrandomized comparative study METHODS: Setting: Cloud-based survey.
Study Population: Children aged 2 to 17 years who underwent a single surgical intervention for ACE.
Interventions: Botulinum toxin injection ("chemodenervation" group) or strabismus surgery ("surgery" group).
Main Outcome Measures: Primary measure: success rate at 6 months in propensity-matched cohort, defined as total horizontal deviation of 10 prism diopters or less with evidence of binocular single vision. Secondary measure: Risk factors for poor outcomes in the full cohort.
Results: Surgeons from 19 centers contributed. There were 74 patients in the chemodenervation group and 97 patients in the surgery group. In the propensity-matched data (n = 98), success rate was not significantly different at 6 months (70.2% vs 79.6%; P = .2) and 12 months (62.9% vs 77.8%; P = .2), but was significantly lower in the chemodenervation group at 24 months (52% vs 86.4%; P = .015). Irrespective of treatment modality, treatment delay was associated with lower success rates at 6 months, with median time from onset to intervention 4.5 months (interquartile range (IQR): 2.1, 6.7) in the success group and 7.7 months (IQR: 5.6, 10.1) in the failure group (P < .001).
Conclusions: In children with ACE, success rate after chemodenervation was similar to that of surgery for up to 12 months but lower at 24 months. Those with prompt intervention and no amblyopia had the most favorable outcomes, regardless of treatment modality.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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