Early retreatment of infantile esotropia: comparison of reoperation and botulinum toxin.

AIM To compare the efficacy of reoperation and botulinum toxin injection in treating infantile esotropes early after unsatisfactory surgical alignment. METHODS 55 strabismic children who had been unsuccessfully operated for infantile esotropia were randomised to reoperation (28 patients) or botulinum toxin injection (27 patients). The motor outcomes (percentage of successful motor outcome and percentage change in deviation) were compared at 6 months, 1 year, and 3 years after retreatment, and the sensory outcomes (percentage with fusion ability and stereo perception) at the 3 year follow up visit. RESULTS The motor and sensory outcomes and the stability of motor results were similar in patients reoperated and treated with botulinum injection. At the 3 year visit 67.8% and 59.2% of children were, respectively, within 8 prism dioptres of orthotropia (p=0.72). The frequency of fusion ability was, respectively, 60.7% and 51.8% (p=0.71), and the frequency of stereo perception (</=400 seconds of arc, Randot circles), 57.1% and 48.1% (p=0.70). The botulinum injection was more likely to be effective when carried out in the 6 months following initial surgery. CONCLUSIONS Botulinum injection is a rapid and less invasive alternative to reoperation in children who have been unsuccessfully treated with surgery to correct infantile esotropia.