Acute Acquired Comitant Esotropia with Myopia: Longer-Term Follow-Up of Botulinum Toxin vs. Strabismus Surgery in a Western Population

Acute’ Acquired Comitant Esotropia with myopia (AACEM) is an unusual form of non-paretic, diplopia-inducing strabismus. It is a subset of (acute) acquired comitant esotropia with recent reports of increasing prevalence. No reports exist comparing botulinum toxin (BTX) to surgery beyond the six-month therapeutic effect of BTX in a western population. Clinical characteristics of AACEM are defined and immediate and longer-term results of both interventions are reported in this retrospective review of 16 cases from two centres. Eight cases received BTX and eight cases had primary surgical intervention. Mean distance and near angle pre-surgery was 37.50±10.35 prism diopters (PD) and 35.63±12.66 PD respectively. Mean distance and near angle at final follow-up post-surgery (475.88±301.21 days, median 466.5) was 5.62±3.78 PD and 5.88±5.25 PD respectively. Mean distance and near angle pre-BTX was 36.00±15.33 PD and 38.75±14.58 PD respectively. Mean distance and near angle at final follow-up post-BTX (789±548.98 days, median 700) was 20.13±15.57 PD and 22.25±17.85 PD respectively. In this the longer-term follow-up study surgery was found to be superior as compared to BTX post-intervention. Surgical alignment also appeared more stable