@article {1302167,
	title = {The Effect of Botulinum Toxin Augmentation on Strabismus Surgery for Large-Angle Infantile~Esotropia},
	journal = {Am J Ophthalmol},
	volume = {189},
	year = {2018},
	month = {2018 May},
	pages = {160-165},
	abstract = {PURPOSE: To determine whether botulinum toxin augments the effect of strabismus surgery in pediatric patients with large-angle infantile esotropia.

DESIGN: Retrospective, comparative, case series.

METHODS: Setting: Tertiary-care pediatric hospital.

STUDY POPULATION: Patients with large-angle infantile esotropia.

INTERVENTION: Treatment with botulinum toxin-augmented bilateral medial rectus muscle recessions ("augmented-surgery group") or traditional bilateral medial rectus muscle recessions ("surgery-only group").

MAIN OUTCOME MEASURE: The effect of surgery on ocular alignment at 4~months, measured in prism diopters of change per mm of surgery (PD/mm).

RESULTS: There were 14 patients in the augmented-surgery group and 16 patients in the surgery-only group. The mean effect on alignment was significantly greater in the augmented-surgery group compared to the surgery-only group at 4~months (5.7 {\textpm} 1.3 vs 4.0 {\textpm} 1.4 PD/mm, P~= .002) and at 1 year (5.4 {\textpm} 1.2 vs 3.7 {\textpm} 1.2 PD/mm, P~= .002). There was a partial loss of treatment effect between 4~months and 1 year in both groups, which was similar in magnitude (P~=~.57). On linear regression, there was a trend toward a positive correlation between botulinum toxin dose and treatment effect, but this was not statistically significant (P~= .09).

CONCLUSIONS: Botulinum toxin augments the surgical effect of medial rectus muscle recession. Botulinum toxin-augmented surgery may be an alternative to traditional options for large-angle infantile esotropia. A surgical dosing table is proposed for this technique.},
	issn = {1879-1891},
	doi = {10.1016/j.ajo.2018.02.010},
	author = {Wan, Michael J and Gilbert, Aubrey and Kazlas, Melanie and Wu, Carolyn and Mantagos, Iason S and Hunter, David G and Shah, Ankoor S}
}
