RETREATMENT OF CHILDREN AFTER SURGERY FOR ACQUIRED ESOTROPIA - REOPERATION VERSUS BOTULINUM INJECTION

Aims-Two viable options were compared, reoperation and botulinum toxin injection, in the management of children who need retreatment after s urgery for acquired esotropia. Methods-47 strabismic children previous ly operated to correct an acquired esotropia were randomised to reoper ation or botulinum toxin injection. Reoperation was undertaken in 24 o f these patients and botulinum toxin injection in 23 of them. The perc entage net change in distance deviation, the percentage of patients wi th successful motor outcome, detectable fusion, and stereopsis were co mpared 1 year after retreatment and at last visit (average follow up: 2.9 years in reoperation group, and 2.7 years in botulinum group). The motor success rate relative to time elapsed from initial surgery was evaluated. Results-There was no significant difference in the motor an d sensory outcomes between patients reoperated and treated with botuli num injection. The frequency of correction to within 8 prism dioptres of orthotropia was, respectively: 75% versus 69.56% at 1 year; 70.83% versus 60.86% at last visit. Botulinum injection could be more effecti ve when performed within 3 months of initial surgery. Conclusions-Botu linum injection is a rapid and safe procedure that may be as effective as reoperation in the management of children who need a secondary pro cedure after surgery for acquired esotropia.