Search

Purpose. - To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia. Methods. - A retrospective, single-center study was performed at the university medical centerin Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test. Results. - We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months +/- 30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR = 0.43). The mean pre-injection deviation was 41.25 +/- 12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%-64.5%). The change in mean angle at 1, 6,12 and 24 months post-injection was -8.57 +/- 25.21 D; 14.48 +/- 13.40 D; 18.38 +/- 12.07 D and 21.23 +/- 14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n = 8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P = 0.039% CI 95% (0.002; 1.0606). Conclusion. - Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n = 27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery. (c) 2021 Elsevier Masson SAS. All rights reserved.; Objectif: Évaluer l’efficacité à long terme de la toxine botulique dans le traitement de l’ésotropie précoce grâce au pourcentage de microtropie à 24 mois post-injection. L’objectif secondaire était de rechercher les facteurs prédictifs à l’obtention de cette microtropie. Méthodes: Nous avons réalisé une étude rétrospective, monocentrique au Centre Hospitalier universitaire (CHU) de Bordeaux entre 2001 et 2018 en incluant tous les patients ayant une ésotropie précoce. Ces patients ont reçu une injection bilatérale de 5 ou 7,5 unités de toxine botulique à une ou deux reprises en fonction de l’angle après la première injection et port de la correction optique totale. L’ensemble des caractéristiques sociodémographiques et ophtalmologiques ont été recueillis en préopératoire. Nous avons noté l’angle à 1,6,12 et 24 mois ; l’apparition de complications ainsi que la nécessité d’une chirurgie de strabisme à distance. Le critère de jugement principal était l’obtention d’une microtropie inférieure à 8 dioptries (D) à 24 mois post-injection. Nous avons évalué les facteurs prédictifs de la microtropie par un test de Fischer. Résultats: Nous avons inclus 30 patients ayant une ésotropie supérieure à 20 D avec un délai moyen de suivi post-injection de 48 mois ± 30. L’âge moyen était de 16,24 mois (7–29 mois) avec une prédominance féminine dans la population (sex ratio SR = 0,43). L’angle moyen pré-injection était de 41,25 ± 12,17 D. Il y avait une majorité d’hypermétropes légers (40 %) et modérés (40 %). À 24 mois, on obtenait 46,7 % de microtropies (intervalle de confiance : IC 95 % : 28,9 %–64,5 %). L’évolution de l’angle moyen à 1,6,12 et 24 mois post-injection était respectivement de −8,57 ± 25,21 D ; 14,48 ± 13,40 D ; 18,38 ± 12,07 D et 21,23 ± 14,97 D. Aucun facteur n’était prédictif de l’obtention d’une microtropie. Parmi les 30 enfants, 3 ont eu des ptôsis transitoires nécessitant la pose de strips et 12 ont présenté une exotropie à 1 mois. Toutes les complications étaient spontanément résolutives et sans conséquences. 3 enfants ont eu une seconde injection de toxine botulique permettant dans 2/3 des cas l’obtention d’une microtropie durable. 26,7 % (n = 8) des enfants ont été opérés secondairement ; l’obtention d’une microtropie à 24 mois diminuait de façon statistiquement significative les chirurgies secondaires du strabisme : p = 0,039 % IC 95 % (0,002 ; 1,0606). Conclusion: La toxine botulique semble être une alternative moins invasive et plus conservatrice que la chirurgie chez les enfants présentant une ésotropie précoce. Elle permet l’obtention d’une microtropie dans 46,7 % des cas. On notait une amélioration chez 90 % (n = 27) des enfants avec une réduction de la moitié (21,23 D) de l’angle moyen post-injection à 24 mois. Lorsqu’elle est efficace elle réduit significativement les chirurgies secondaires.

To evaluate long terms outcomes of botulinum toxin in infantile esotropia by measuring the amount of microtropia 24 months after injection. Secondary purpose was to identify predictive factors of microtropia.A retrospective, single-center study was performed at the university medical center in Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice depending on the angle of deviation after the first injection and after wearing full optical correction at least two months. We noted the angle at 1, 6, 12 and 24 months, the occurrence of any complications and the need for later strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors for microtropia with a Fischer's test.We included 30 patients with esotropia greater than 20 D. The mean follow-up after injection was 48 months ±30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR=0.43). The mean pre-injection deviation was 41.25±12.17 D. The majority of patients were mildly (40%) or moderately (40%) hyperopic. At 24 months, 46.7% microtropias were obtained (95% CI: 28.9%-64.5%). The change in mean angle at 1, 6, 12 and 24 months post-injection was -8.57±25.21 D; 14.48±13.40 D; 18.38±12.07 D and 21.23±14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 showed an exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n=8) of the children underwent secondary surgery. Obtaining a microtropia 24 months after injection statistically significantly reduced the need for secondary strabismus surgery: 92.9% P=0.039% CI 95% (0.002; 1.0606).Botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n=27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces the need for secondary surgery.