# Acute-onset Concomitant Esotropia in Children: A Comparison of Clinical Features and Treatment Outcomes

## TL;DR

This study compares botulinum toxin injections and surgery for treating a type of eye misalignment in children and finds both methods effective.

## Contribution

The study provides a direct comparison of BTX-A and surgery for acute-onset concomitant esotropia in children, focusing on motor and sensory outcomes.

## Key findings

- Both BTX-A and surgery achieved high motor success rates (90-95%) in correcting eye alignment.
- Sensory outcomes like fusion and stereopsis were also similar between the two treatment groups.
- Type II was the most common classification of ACE, and treatment success was not affected by the subtype.

## Abstract

To evaluate and compare the clinical features and efficacy of botulinum toxin A (BTX-A) injection versus surgery in acute-onset concomitant esotropia (ACE) in children.

This retrospective comparative clinical study was conducted on 40 children with ACE. The patients were assigned to either the surgery group (n = 23) or the BTX-A group (n = 17). Successful motor outcomes were defined as residual esodeviation of
<
5 prism diopters (PD), while successful sensory outcomes were defined as the presence of any evidence of sensory fusion or stereopsis.

The average treatment age in this study was 7.02
±
3.72 years in the BTX-A group and 6.41
±
2.83 years in the surgery group. There were 5 cases of type I (12.50%), 26 cases of type II (65.00%), and 9 cases of type III (22.50%) for ACE. The deviation before treatment was +(41.35
±
16.90) PD at near and +(39.71
±
14.94) PD at distance in the BTX-A group. In the surgery group, the results were +(49.22
±
18.25) PD at near and +(47.00
±
18.53) PD at distance. After treatment, based on the measured deviation, total motor success was 95.00% (38/40) at near and 90.00% (36/40) at distance. Following treatment, 94.59% (35/37) of patients with ACE exhibited fusion, 86.84% (33/38) had near stereopsis, and 72.97% (27/37) had distance stereopsis. The motor and sensory success rates were not significantly different between the BTX-A and surgery groups. There were no statistically significant differences in motor outcomes or sensory outcomes among the three subtypes of ACE (all P

>
0.05).

In our study, type II was the most common clinical classification for ACE. Favorable outcomes could be achieved with both BTX-A injection and surgery. There was no difference in motor or sensory outcomes regardless of clinical classification. BTX-A injection is minimally invasive, allows early intervention, and may be the preferred approach for managing ACE in children.