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Master Thesis

Évaluation à long terme de l'efficacité de la toxine botulique dans l'ésotropie précoce

Abstract : Purpose: to evaluate long terms outcomes of botulinum toxin in infantile esotropia with the amount of microtropia 24 months after injection. Secondary purpose was to search predictive factors of microtropia. Methods: retrospective, single-center study was performed in university hospital center in Bordeaux between 2001 and 2018, including all patients with infantile esotropia greater than 20 D. All patients received 5 or 7,5 IU of botulinum toxin A in each medial rectus, once or twice, after wearing full optical correction at least two months. We noted the angle at 1,6,12 and 24 months; the occurrence of complications and the need for secondary strabismus surgery. The primary endpoint was the achievement of a microtropia less than 8 diopters (D) at 24 months post-injection. We evaluated the predictive factors of microtropia by a Fischer's test. Results: we included 30 patients with an esotropia greater than 20 D. Mean follow up was 48 months ±30. The mean age was 16.24 months (7-29 months) with a female predominance in the population (SR=0.43). The mean pre-injection angle was 41.25 ±12.17 D. There was a majority of mild (40%) and moderate (40%) hyperopia. At 24 months, 46.7% of microtropias were obtained (95% CI : 28.9% - 64.5%). The change in mean angle at 1.6,12 and 24 months post-injection was -8.57±25.21 D ; 14.48±13.40 D; 18.38±12.07 D and 21.23±14.97 D, respectively. No factors were predictive of microtropia. Of the 30 children, 3 had transient ptosis requiring strips and 12 had exotropia at 1 month. All complications were self-limited and without consequences. 3 children had a second injection of botulinum toxin, which in 2/3 of the cases resulted in a long-lasting microtropia. 26.7% (n=8) of the children underwent secondary surgery. Getting microtropia 24 months after injection statistically significantly reduced secondary strabismus surgery: 92.9% p =0.039% CI 95% (0.002; 1.0606). Conclusion: botulinum toxin appears to be a less invasive and more conservative alternative to surgery in children with infantile esotropia. In 46.7% of cases, microtropia is achieved. An improvement was noted in 90% (n=27) of the children with a reduction of half (21.23 D) of the mean post-injection angle at 24 months. When effective, it significantly reduces secondary surgery.
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Sarah Koudsie. Évaluation à long terme de l'efficacité de la toxine botulique dans l'ésotropie précoce. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02945510⟩

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