To compare the efficacy of botulinum toxin injections to strabismus surgery in children with acute, acquired, comitant esotropia (ACE), and to investigate factors predicting success. International, multi-center nonrandomized comparative study Setting: Cloud-based survey. Study population: Children aged 2 to 17 years who underwent a single surgical intervention for ACE. Interventions: Botulinum toxin injection (“chemodenervation” group) or strabismus surgery (“surgery” group). Main outcome measures: Primary measure: success rate at 6 months in propensity-matched cohort, defined as total horizontal deviation of 10 prism diopters or less with evidence of binocular single vision. Secondary measure: Risk factors for poor outcomes in the full cohort. Surgeons from 19 centers contributed. There were 74 patients in the chemodenervation group and 97 patients in the surgery group. In the propensity-matched data ( = 98), success rate was not significantly different at 6 months (70.2% vs 79.6%; = .2) and 12 months (62.9% vs 77.8%; = .2), but was significantly lower in the chemodenervation group at 24 months (52% vs 86.4%; = .015). Irrespective of treatment modality, treatment delay was associated with lower success rates at 6 months, with median time from onset to intervention 4.5 months (interquartile range (IQR): 2.1, 6.7) in the success group and 7.7 months (IQR: 5.6, 10.1) in the failure group ( < .001). In children with ACE, success rate after chemodenervation was similar to that of surgery for up to 12 months but lower at 24 months. Those with prompt intervention and no amblyopia had the most favorable outcomes, regardless of treatment modality.

中文翻译：

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化学神经支配与切口手术治疗急性、获得性、伴随性内斜视的比较：一项国际研究

比较肉毒杆菌毒素注射与斜视手术对患有急性、获得性、伴随性内斜视 (ACE) 的儿童的疗效，并调查预测成功的因素。国际多中心非随机比较研究 背景：基于云的调查。研究人群：接受过单次 ACE 手术干预的 2 至 17 岁儿童。干预措施：肉毒毒素注射（“化学去神经”组）或斜视手术（“手术”组）。主要结果指标： 主要指标：倾向匹配队列中 6 个月时的成功率，定义为总水平偏差为 10 棱镜屈光度或更少，并有双眼单视证据。次要衡量标准：整个队列中预后不良的风险因素。来自 19 个中心的外科医生做出了贡献。化学去神经组有74例患者，手术组有97例患者。在倾向匹配数据 ( = 98) 中，6 个月 (70.2% vs 79.6%; = .2) 和 12 个月 (62.9% vs 77.8%; = .2) 时的成功率没有显着差异，但明显较低在 24 个月时化学去神经组中（52% vs 86.4%；= .015）。无论采用何种治疗方式，治疗延迟与 6 个月时的成功率较低相关，成功组从发病到干预的中位时间为 4.5 个月（四分位距 (IQR)：2.1、6.7），而成功组则为 7.7 个月（IQR：5.6、10.1）。 ) 属于失败组 (< .001)。在患有 ACE 的儿童中，化学去神经术后 12 个月内的成功率与手术相似，但在 24 个月时较低。无论采用何种治疗方式，那些得到及时干预且没有弱视的患者都获得了最有利的结果。