CONTRIBUTION OF LATE BOTULINUM TOXIN INJECTION AS THE FIRST LINE TREATMENT FOR INFANTILE ESOTROPIA

Purpose Evaluation of botulinum toxin to treat esotropia in children o ver 3 years old.Material and methods Eight children (6 boys and 2 girl s), aged from 3 to 6 years (mean 4), underwent bilateral injection of 1.25 UI botulinum toxin. Botox(R) in medical rectus muscles, under gen eral anesthesia. Preoperative diagnosis was infantile esotropia in 7 c ases, and decompensated esophoria in 1 case. Six children had alternat ing isoacuity before injection, and two had ambylopia. Mean follow-up was 1.8 months (6 to 24 months). Results One transient exotropia, and one transient ptosis were reported. Lasting orthotropia was achieved i n four children (including one who presented again spasms in near visi on), and lasting angle reduction ist another child. Another child had late recurrence at 18 months. The injection was a failure for the two amblyopic children. Discussion Botulinum therapy allowed to avoid surg ery in three cases, and to perform a more limited operation in one cas e. Conclusion Botulinum toxin injection in extraocular muscles is of i nterest in infantile esotropia as a first treatment, even in children over 3 years. The success relies principally an the absence of deep am blyopia, and muscular elongation troubles. However, the use of botulin um is limited, because it requires general anesthesia, and because of its price.