Use of Botulinum Toxin A in the Treatment of Intermittent Exotropia: Factors Affecting Treatment Outcome

Kunduracı, Merve Sena; Kantarcı, Büşra; Erşan, Hatice Bilge Araz; Tuğcu, Betül

doi:10.1080/08820538.2022.2048031

Cited by 3 publications

(2 citation statements)

References 17 publications

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“…The timing of treatment is critical. For patients with the normal eye position, abnormal binocular parallax caused by anisometropia is the main cause of stereovision [ 22 , 23 ]. Therefore, for the treatment of IXT, it is not enough to consider only the eye position; anisometropia is also important.…”

Section: Discussionmentioning

confidence: 99%

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

Zhao,

Fu,

et al. 2024

BMC Ophthalmol

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Objective To investigate the recovery of binocular stereopsis recovery and its influencing factors in children with intermittent exotropia after successful correction of eye position. Methods Prospective clinical study. A total of 178 patients, aged 9 ∼ 14 (10.8 ± 1.7) years, who were successfully corrected after intermittent exotropia surgery at the Beijing Tongren Hospital Affiliated to Capital Medical University from October 2023 to September 2023 were collected, the follow-up duration was six-month or longer. Paired t test, Pearson correlation analysis and multivariable linear regression analysis were used to probe preoperative clinical features that may predict the stereopsis six months after surgery. Results Six months after surgery, the angle of deviation of the patients met the orthotopic standard, and there was significant difference compared with that before surgery (distant: -2.7△±3.2△ vs. -30.5△±8.4△, t=-25.3, P < 0.001. Near:-3.7△±4.1△ vs. -33.7△±8.0△, t=-26.1, P < 0.001). Distant stereopsis (3.0 ± 0.6 vs. 3.9 ± 0.4, t = 4.9, P < 0.05) and near stereopsis (2.3 ± 0.5 vs. 2.6 ± 0.4, t = 3.8, P < 0.05) were both significantly improved compared with that of before surgery. 17% and 22% patients rebuilt normal distant stereopsis and normal near stereopsis, respectively. Preoperative distant stereopsis (r=-0.26, P = 0.004) and near stereopsis (r=-0.23, P = 0.011) was significantly negatively correlated with convergence reserve. Multivariable analysis showed that patients’ age (β = 0.003, p = 0.037), anisometropia (β = 0.015, p = 0.043), and preoperative distant stereopsis (β = 0.456, p < 0.001) were significantly associated with postoperative distant stereopsis. Patients’ age (β = 0.005, p = 0.044), anisometropia (β = 0.127, p = 0.034), angle of deviation (β=-0.230, p = 0.020), and preoperative near stereopsis (β = 0.136, p < 0.001) were significantly associated with postoperative near stereopsis. Conclusion IXT patients could get eye position fixed after surgery, about 20% patients benefited from stereopsis improvement. Patient’s age, binocular anisometropia, angle of deviation and preoperative stereopsis were independent factors influencing postoperative stereopsis.

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Section: Discussionmentioning

confidence: 99%

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

Zhao,

Fu,

et al. 2024

BMC Ophthalmol

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“…Large angle intermittent exotropia can be managed by different surgical techniques with variable success rates [16][17][18][19] . Previous studies evaluated the BTA use to augment the effect of surgery in recession-resection procedures for the correction of different types of exotropia [12][13][14]20] , other studies have evaluated the use of BTA alone for the treatment of intermittent exotropia with variable success rates [21][22][23] . To the best of our knowledge, this is the first study to compare the effect of BTA augmented bilateral lateral recti recession with the effect of surgery on three recti muscles for the correction of the large angle intermittent exotropia.…”

Section: Discussionmentioning

confidence: 99%

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

Mattout¹,

El-Haig²

2022

Int J Ophthalmol

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AIM: To report the surgical outcomes of correcting large angle intermittent exotropia in adult patients by bilateral lateral rectus muscle recession with intraoperative use of botulinum toxin and to compare the results with those of bilateral lateral rectus muscle recession and unilateral medial rectus resection. METHODS: The medical records of patients who underwent surgical correction of large angle intermittent exotropia [exotropia >50 prism dioptre (PD)] were retrospectively reviewed. Two groups of patients were identified; Group I (21 patients) had bilateral lateral recti recession augmented with intraoperative botulinum toxin A (BTA) injection into the recessed muscles and group II (30 patients) were treated by bilateral lateral recti recession with unilateral medial rectus muscle resection. Preoperative data were extracted for age, gender, refraction, type of exotropia, angle of stereopsis and angle of deviation. The main outcome measures were the postoperative angle of deviation and stereoacuity angle by Titmus test measured at the end of one year of postoperative follow up. RESULTS: By the end of the first postoperative year, 10 patients in group I (47.6%) and 20 patients in group II (66.7%) achieved esotropia/esophoria <5 PD or exotropia/exophoria <10 PD. The difference in surgical success rate was not statistically significant (P=0.1) but there was a statistically significant higher rate of undercorrection in group I (P=0.03). On the other hand, 3 patients in group I (14.3%) and 5 patients in group II (16.7%) had improved stereopsis; this difference in the sensory outcome was not statistically significant (P=0.8). In the BTA augmented surgery group, good stereoacuity and smaller preoperative angle of deviation were associated with significantly higher surgical success rate (P=0.004, 0.01 respectively). CONCLUSION: BTA augmented bilateral lateral recti recession is associated with higher rate of undercorrection as compared to bilateral lateral recti recession with unilateral medial rectus resection in the correction of large angle intermittent exotropia. The surgical success rate in BTA augmented surgery group is observed to be higher in patients with preoperative smaller angle of deviation and in patients with good stereoacuity.

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Dose-Effect Relationship of Botulinum Toxin Type A in the Management of Strabismus: A Review

Alhejaili,

Alkayyal,

Alawaz

et al. 2024

Cureus

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Use of Botulinum Toxin A in the Treatment of Intermittent Exotropia: Factors Affecting Treatment Outcome

Cited by 3 publications

References 17 publications

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

Six-month binocular stereopsis recovery and its influencing factors in children with intermittent exotropia

Botulinum toxin augmented bilateral lateral rectus recession versus three muscles surgery in large-angle intermittent exotropia

Dose-Effect Relationship of Botulinum Toxin Type A in the Management of Strabismus: A Review

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