Efficacy of Botulinum Toxin Type A for Acute Acquired Comitant Esotropia: An Age-Stratified Two-Year Follow-Up Study

Efficacy of Botulinum Toxin Type A for Acute Acquired Comitant Esotropia: An Age-Stratified Two-Year Follow-Up Study

The goal of this clinical trial is to assess and compare the efficacy of two-year follow-up botulinum toxin type A （BTXA) in the treatment of acute acquired comitant esotropia (AACE) across five age groups: ≤6 years, >6 to ≤12 years, >12 to ≤20 years, >20 to ≤30 years, and >30 years. For patients >12 years presenting with large-angle esotropia (>50 PD), primary surgical intervention was recommended as the preferred approach to minimize failure and recurrence risk. Conversely, for patients ≤12 years, BTXA injection was maintained as the first-line treatment regardless of the deviation angle.

Inclusion Criteria:

• Clinical diagnosis of acute acquired comitant esotropia (AACE) with sudden onset and diplopia
• Normal eye movements with deviation difference ≤5 prism diopters (PD) in all gaze directions
• Hyperopia < +3.00 diopters
• <10 PD reduction in esotropia with hypermetropic spectacle correction
• No prior extraocular muscle surgery
• Absence of congenital/developmental anomalies affecting treatment outcomes

Exclusion Criteria:

• Deviation difference >5 PD in any gaze direction
• Hyperopia ≥ +3.00 diopters
• History of extraocular muscle surgery
• Presence of congenital/developmental anomalies potentially impacting outcomes