Botulinum toxin-A in acute acquired comitant esotropia during COVID pandemic in children and young adolescents.

Publisher: Medknow Publications Country of Publication: India NLM ID: 0405376 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1998-3689 (Electronic) Linking ISSN: 03014738 NLM ISO Abbreviation: Indian J Ophthalmol Subsets: MEDLINE

Publication: Mumbai : Medknow Publications
Original Publication: Bombay : All-India Ophthalmological Society

Esotropia*/drug therapy ; Esotropia*/physiopathology ; Esotropia*/etiology ; Esotropia*/epidemiology ; Botulinum Toxins, Type A*/administration & dosage ; COVID-19*/epidemiology ; Vision, Binocular*/physiology ; Oculomotor Muscles*/physiopathology ; Oculomotor Muscles*/drug effects ; SARS-CoV-2* ; Eye Movements*/physiology; Humans ; Retrospective Studies ; Adolescent ; Child ; Female ; Male ; Acute Disease ; Neuromuscular Agents/administration & dosage ; Child, Preschool ; Injections, Intramuscular ; Treatment Outcome ; Follow-Up Studies ; India/epidemiology ; Young Adult ; Pandemics

Purpose: To study the effectiveness of botulinum toxin A (BTX-A) in the treatment of patients with acute acquired comitant esotropia (AACE) due to excessive use of mobile and laptops in the COVID era in the pediatric population and adolescents.
Methods: This was a retrospective, interventional study of pediatric patients and young adults who presented with AACE and received unilateral or bilateral BTX-A. All the patients complained of binocular diplopia and sudden onset of esotropia with a history of mobile or laptop usage during the COVID era (2020-2023). Twenty-seven patients with acute-onset esotropia in 3 years (2020-2023) were included. All patients were administered 2.5-7.5 units of BTX-A (Botox, Allergan, India) into the unilateral or bilateral medial rectus muscle of the deviating eye under short general anesthesia or local anesthesia. The main outcome measures were pre- and post-injection angle of deviation, pre- and post-injection stereopsis, final level of stereopsis achieved, recurrence, and whether strabismus surgery was later required.
Results: The mean age of patients was 12.85 ± 7.15 years (range: 4-25 years). The mean dosage of Botox was 6 U (2.5-7.5 U). The mean follow-up was 6 months (6 months-2 years). The mean preoperative angle of deviation (AOD) was 41.11 ± 10.9 prism diopters (PD) for distance and 41.67 ± 10.9 PD for near. The maximum effect of BTX-A was seen at 1 month; post-injection AOD was 13.65 ± 14.7 PD for distance and 14.87 ± 15.8 PD for near ( P < 0.001). Over half of the patients achieved optimal outcomes, with improvements in stereopsis and sensory fusion. Early intervention (within 3 months of symptom onset) significantly correlated with treatment success.
Conclusion: While BTX-A therapy for acute-onset esotropia demonstrates efficacy, patient-specific considerations are essential. This study highlights the evolving nature in the digital age and early administration of BTX-A along with close follow-up to monitor residual and recurrence of esotropia. The surgical intervention can increase the final success rate.
(Copyright © 2024 Indian Journal of Ophthalmology.)

Front Med (Lausanne). 2023 Aug 04;10:1219419. (PMID: 37601790)
BMC Ophthalmol. 2016 Apr 09;16:37. (PMID: 27061181)
Clin Exp Optom. 2020 Jul;103(4):555. (PMID: 32396988)
Front Public Health. 2022 Aug 11;10:945082. (PMID: 36033797)
J Pediatr Ophthalmol Strabismus. 2018 Dec 19;55:e42-e44. (PMID: 30571837)
BMJ Open. 2022 Aug 3;12(8):e062388. (PMID: 35922104)
J Pediatr Ophthalmol Strabismus. 2020 Oct 20;57:e88-e91. (PMID: 33090234)
Graefes Arch Clin Exp Ophthalmol. 2023 Sep;261(9):2661-2668. (PMID: 37067584)
J Pediatr Ophthalmol Strabismus. 2020 Jul 1;57(4):251-256. (PMID: 32687210)
Clin Ophthalmol. 2021 Apr 15;15:1567-1572. (PMID: 33883873)
Int J Ophthalmol. 2022 Nov 18;15(11):1845-1851. (PMID: 36404961)
Eye (Lond). 2023 Feb;37(2):320-324. (PMID: 35075284)
PLoS One. 2023 May 18;18(5):e0280968. (PMID: 37200284)
Semin Ophthalmol. 2017;32(1):8-13. (PMID: 27726470)
Graefes Arch Clin Exp Ophthalmol. 2020 Sep;258(9):2069-2070. (PMID: 32367286)
Am J Ophthalmol. 1958 Apr;45(4 Pt 2):55-64. (PMID: 13520873)
Indian J Ophthalmol. 2022 Apr;70(4):1359-1364. (PMID: 35326055)
Strabismus. 2021 Sep;29(3):163-167. (PMID: 34223812)
Obesity (Silver Spring). 2020 Aug;28(8):1382-1385. (PMID: 32352652)
Strabismus. 2022 Jun;30(2):59-64. (PMID: 35291920)
Br J Ophthalmol. 1995 May;79(5):498-501. (PMID: 7612566)
Ophthalmology. 2021 Dec;128(12):1766-1776. (PMID: 34176652)
BMC Ophthalmol. 2021 Jan 6;21(1):9. (PMID: 33407264)
Medicine (Baltimore). 2023 Jun 2;102(22):e33986. (PMID: 37266605)

EC 3.4.24.69 (Botulinum Toxins, Type A)
0 (Neuromuscular Agents)

Date Created: 20240919 Date Completed: 20250424 Latest Revision: 20250424

20250424

PMC11991551

10.4103/IJO.IJO_2540_23

39297475