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BOTOX vs. SURGERY FOR SMALL / MODERATE ANGLE ESOTROPIA

(12/03)

BOTOX works by causing a temporary large overcorrection [lasts several weeks] to produce a small permanent change. SURGERY realigns the eye[s] by shifting muscles around and there is usually little/ no change to the alignment once everything settles.

CRITERION BOTOX SURGERY
Reliability    
1 Treatment 50+% 80-90%
2 Treatments ? 60-70%  
Usual outcome 5-10º shift as needed
Investment    
Time 30 minutes anesthesia.
  Walk in / walk out 24 h in hospital
  Eye pad 2 hours 1 week off work
Surgeon time 5 minutes 45 minutes to 2 hrs+
$ $300 per Rx no insurance: $3K +
    Insurance: $1-2K
Need for 2nd Rx 50% 10-20%
Inadequate result    
Improved by Botox & / or surgery Botox & / or surgery
Complications droopy lid 15% uncommon
       Acquired vertical 15%  
       99% recovery for both  

 

EDUCATIONAL UPDATE

SEPTEMBER 2003


20 years after Botox was developed in the hope that it would replace strabismus surgery, there has still been no prospective randomised trial in strabismus!

Dr. Kowal has been using Botox for strabismus and facial spasms since the late '80s, and believes that for small-moderate angle esotropia the results of strabismus and Botox are comparable.

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