Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia
Reviewed by Jonathan Chan

This is a retrospective study of 104 patients diagnosed with acute acquired concomitant esotropia (AACE) between 2020 and 2022. Potential factors that influence the dose-response of bilateral medial rectus recession (MRec) and the rate and risk factors for ACCE relapse were evaluated by multivariable linear regression analysis and Kaplan-Meier survival analysis respectively. Thirty-one had augmented-dosed surgery (ADS) and 73 had botulinum toxin (BTXA). During the two-year follow-up period, there was no recurrence of diplopia and stable angle in the ADS group, and 68.8% of the BTXA group achieved orthophoria; this group also identified that hours of near work per day were demonstrated as a significant risk factor for AACE relapse. The dose-response of ADS for bilateral MRec was positively correlated with preoperative angle (p<0.001). The authors concluded that ADS would achieve a more stable outcome for ACCE patients compared with BTXA treatment. Botulinum toxin is still proposed for small angle ACCE due to advantages of reduced trauma, operational simplicity, low cost and quick recovery.

Efficacy of augmented-dosed surgery versus botulinum toxin A injection for acute acquired concomitant esotropia: a 2-year follow-up.
Yu X, Pan W, Tang X, et al.
BRITISH JOURNAL OF OPHTHALMOLOGY
2024;108:1044–8.