Yasser Almuzaini, Taghreed Alnajjar, Shatha Alfrehi
PurposeTo compare the success rates of botulinum toxin (BTX) injection and conventional strabismus surgery in treating residual esotropia. MethodsThis retrospective cohort study included patients with residual esotropia of >15Δ following strabismus surgery treated at a single instituion from 2015 to 2023. Patients were categorized into two groups based on intervention type: the surgery group and the BTX group. The success rate was defined as an angle of deviation of <10Δ of esotropia during the last follow-up, at least 3 months after the last intervention. ResultsA total of 41 patients were included: 20 in the surgery group and 21 in the BTX group. No statistically significant differences were observed between the groups in terms of age, sex, spherical equivalent, amblyopia, diagnosis, or preintervention angle of deviation. Mean preintervention angles of deviation were 25.40Δ ± 9.36Δ in the surgical group and 25.14Δ ± 6.76Δ in the BTX group, which decreased to 10.45Δ ± 9.36Δ and 11.52Δ ± 13.11Δ, respectively, after treatment, with no statistically significant difference (P = 0.555). The success rates were 47.6% in the BTX group and 60% in the surgery group (P = 0.427). Exotropia developed in a single patient in each group. Dissociated vertical deviation developed in 2 patients from the surgical group and 1 patient from the BTX group. In the surgical group, 2 patients developed hypertropia; in the BTX group, 4 patients. ConclusionsBTX is comparable to conventional surgery and can be considered in the management of residual esotropia.