<clinical_study>
  <!-- This xml conforms to an XML Schema at:
    https://clinicaltrials.gov/ct2/html/images/info/public.xsd -->
  <required_header>
    <download_date>ClinicalTrials.gov processed this data on September 20, 2023</download_date>
    <link_text>Link to the current ClinicalTrials.gov record.</link_text>
    <url>https://clinicaltrials.gov/ct2/show/NCT03266549</url>
  </required_header>
  <id_info>
    <org_study_id>Botox Horizontal Strabismus</org_study_id>
    <nct_id>NCT03266549</nct_id>
  </id_info>
  <brief_title>Botulinum Toxin Augmented Surgery vs Conventional Surgery in the Management of Large Angle Horizontal Deviations</brief_title>
  <official_title>Botulinum Toxin Augmented Surgery Versus Conventional Surgery in the Management of Large Angle Concomitant Horizontal Deviations</official_title>
  <sponsors>
    <lead_sponsor>
      <agency>Assiut University</agency>
      <agency_class>Other</agency_class>
    </lead_sponsor>
  </sponsors>
  <source>Assiut University</source>
  <oversight_info>
    <has_dmc>Yes</has_dmc>
    <is_fda_regulated_drug>No</is_fda_regulated_drug>
    <is_fda_regulated_device>No</is_fda_regulated_device>
  </oversight_info>
  <brief_summary>
    <textblock>
      Horizontal strabismus includes esotropia and exotropia where there is inward or outward&#xD;
      deviation of visual axes of the eyes respectively. The most common initial treatment of&#xD;
      horizontal strabismus is either bilateral rectus muscle recessions or unilateral recession&#xD;
      resection surgery. For large angle deviations (&gt;50 prism diopters [PD]), surgery on 2 muscles&#xD;
      alone may not be adequate with high reoperation rates. Approaches to these patients included&#xD;
      large bilateral muscle recessions, supramaximal unilateral recession resection procedure,&#xD;
      three or four horizontal muscle surgery, or botulinum toxin augmented surgery.&#xD;
&#xD;
      Botulinum toxin augmentated strabismus surgery was reported in several studies. Owens et&#xD;
      al.reported successful botulinum toxin augmentation of monocular recession-resection&#xD;
      surgeries in 3 large-angle exotropia patients with successful results in two of the 3&#xD;
      patients. Khan reported 8 patients with &gt; 60 PD esotropia treated with botulinum-augmented&#xD;
      surgery. Six of 8 had deviations of 10 PD or less following surgery. Özkan et al used&#xD;
      botulinum augmentation in a group of older patients with large angle esotropia of different&#xD;
      etiologies, with a success rate of 57%. Lueder et al evaluated the long-term outcomes in&#xD;
      patients with infantile esotropia. The results were good, with a 74% success rate. Based on&#xD;
      historical comparisons, this technique appears equally as effective as 3- or 4-muscle surgery&#xD;
      and more effective than large bilateral medial rectus recessions alone.&#xD;
&#xD;
      Ideally, a prospective randomized study should be performed to more definitively determine&#xD;
      the effectiveness of intraoperative botulinum toxin augmentation compared to surgery alone.&#xD;
    </textblock>
  </brief_summary>
  <detailed_description>
    <textblock>
      Strabismus is defined as inability of the two eyes to align their visual axes to a common&#xD;
      object of regard. Horizontal strabismus may be in the form of esotropia or exotropia&#xD;
      depending on whether the visual axes and the eyes are converging or diverging respectively.&#xD;
&#xD;
      There are multiple surgical techniques used to treat horizontal strabismus with the main goal&#xD;
      being to align the visual axes so that binocular vision may develop. The most common initial&#xD;
      treatment is either bilateral rectus muscle recessions or unilateral recession resection&#xD;
      surgery. For large angle deviations (&gt;50 prism diopters [PD]), surgery on 2 muscles alone may&#xD;
      not be adequate to correct the strabismus with high reoperation rates. Approaches to these&#xD;
      patients have included large bilateral muscle recessions, supramaximal unilateral recession&#xD;
      resection procedure, three or four horizontal muscle surgery, or botulinum toxin augmented&#xD;
      surgery.&#xD;
&#xD;
      Botulinum toxin exerts its effect by interfering with release of acetylcholine at the&#xD;
      neuromuscular junction, thus inhibiting muscle contraction. Although the pharmacologic effect&#xD;
      of botulinum toxin is temporary, permanent results in patients with strabismus may occur.&#xD;
      These effects include a change in the length-tension curves of the muscles and permanent&#xD;
      changes in sarcomere density and myosin heavy chain composition.&#xD;
&#xD;
      Botulinum toxin alone has been advocated by McNeer and associates as a primary treatment for&#xD;
      infantile esotropia in children with smaller angles of deviation. The advantage of this&#xD;
      approach is that incisional surgery is not required. However, it was found that botulinum&#xD;
      alone was less effective in establishing binocularity when compared to standard surgery. This&#xD;
      is likely because multiple injections are often needed, which prolongs the duration of&#xD;
      misalignment. On the other hand, the concomitant use of botulinum toxin and surgery allowed&#xD;
      for rapid establishment of alignment. Other advantages of botulinum augmentation are that&#xD;
      only 2 muscles are operated upon, thus decreasing anesthesia duration and the risk of&#xD;
      surgical complications, and the lateral rectus muscles are preserved for additional surgery,&#xD;
      if needed.&#xD;
&#xD;
      Botulinum toxin augmentation of strabismus surgery was reported in several previous studies.&#xD;
      Owens et al. reported the successful intraoperative use of botulinum toxin to augment&#xD;
      monocular recession-resection surgeries in three large-angle exotropia patients. Two of these&#xD;
      patients had orthotropia ±10 PD at their final examinations, while the third patient&#xD;
      demonstrated a stable 18 PD exotropia which was cosmetically satisfactory. Khan reported 8&#xD;
      patients with &gt; 60 PD esotropia treated with botulinum-augmented horizontal muscle surgery.&#xD;
      Six of 8 had deviations of 10 PD or less following surgery, with an average follow-up of 9&#xD;
      months. Özkan et al. used botulinum augmentation in a group of older patients (age range 5-50&#xD;
      years) with large-angle esotropia of different etiologies, with a success rate of 57% and an&#xD;
      average follow-up of 14 months. Minguini et al. compared the results of surgery alone versus&#xD;
      surgery plus treatment with botulinum toxin for treatment of 23 patient with large angle&#xD;
      strabismus. Lueder et al. evaluated the long-term outcomes in patients with infantile&#xD;
      esotropia who had been followed for more than 2 years after treatment. The results were good,&#xD;
      with a 74% success rate. This study demonstrated that this procedure is an effective&#xD;
      treatment for infants with large-angle infantile esotropia, with stable results over time2.&#xD;
      Based on historical comparisons, it appears equally as effective as 3- or 4-muscle surgery&#xD;
      and more effective than large bilateral medial rectus recessions alone.&#xD;
&#xD;
      Ideally, a prospective randomized study should be performed to more definitively determine&#xD;
      the effectiveness of the addition of intraoperative botulinum toxin compared to surgery&#xD;
      alone.&#xD;
    </textblock>
  </detailed_description>
  <overall_status>Unknown status</overall_status>
  <last_known_status>Not yet recruiting</last_known_status>
  <start_date type="Anticipated">February 20, 2021</start_date>
  <completion_date type="Anticipated">November 30, 2021</completion_date>
  <primary_completion_date type="Anticipated">August 31, 2021</primary_completion_date>
  <phase>N/A</phase>
  <study_type>Interventional</study_type>
  <has_expanded_access>No</has_expanded_access>
  <study_design_info>
    <allocation>Randomized</allocation>
    <intervention_model>Parallel Assignment</intervention_model>
    <primary_purpose>Treatment</primary_purpose>
    <masking>None (Open Label)</masking>
  </study_design_info>
  <primary_outcome>
    <measure>success rate</measure>
    <time_frame>Patients will be examined at 1 week after surgery</time_frame>
    <description>Outcomes will be considered successful if the patients had orthotropia ±10 PD</description>
  </primary_outcome>
  <secondary_outcome>
    <measure>incidence of complications</measure>
    <time_frame>Patients will be examined at 1 week after surgery</time_frame>
    <description>ptosis vertical deviation under-correction (residual esotropia) overcorrection (consecutive exotropia)</description>
  </secondary_outcome>
  <secondary_outcome>
    <measure>Ocular alignment</measure>
    <time_frame>12 months postoperative</time_frame>
    <description>Orthotropia or angle of deviation if present</description>
  </secondary_outcome>
  <number_of_arms>2</number_of_arms>
  <enrollment type="Anticipated">46</enrollment>
  <condition>Large Angle Horizontal Strabismus</condition>
  <arm_group>
    <arm_group_label>Botulinum toxin augmented surgery group</arm_group_label>
    <arm_group_type>Experimental</arm_group_type>
    <description>unilateral recess-resect procedure, or bilateral rectus muscle recession plus intraoperative injection of 2.5 to 5 units of botulinum toxin A into the recessed muscle.</description>
  </arm_group>
  <arm_group>
    <arm_group_label>conventional surgery group</arm_group_label>
    <arm_group_type>Active Comparator</arm_group_type>
    <description>unilateral recess-resect procedure, bilateral rectus muscle recession, or 3 horizontal rectus muscle surgery according to the type of strabismus and the presence or absence of deep amblyopia.The standard correction tables will be used as a guide for the amount of muscle recession and, or resection</description>
  </arm_group>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>botulinum toxin augmented surgery</intervention_name>
    <description>unilateral recess-resect procedure, or bilateral rectus muscle recession plus intraoperative injection of 2.5 to 5 units of botulinum toxin A into the recessed muscle.</description>
    <arm_group_label>Botulinum toxin augmented surgery group</arm_group_label>
  </intervention>
  <intervention>
    <intervention_type>Procedure</intervention_type>
    <intervention_name>conventional surgery</intervention_name>
    <description>unilateral recess-resect procedure, bilateral rectus muscle recession, or 3 horizontal rectus muscle surgery according to the type of strabismus and the presence or absence of deep amblyopia. The standard correction tables will be used as a guide for the amount of muscle recession and, or resection.</description>
    <arm_group_label>conventional surgery group</arm_group_label>
  </intervention>
  <eligibility>
    <criteria>
      <textblock>
        Inclusion Criteria:&#xD;
&#xD;
          -  Large angle concomitant horizontal strabismus (&gt;50 prism diopters)&#xD;
&#xD;
        Exclusion Criteria:&#xD;
&#xD;
          -  Other neurologic, or developmental disorders&#xD;
&#xD;
          -  Vertical deviation&#xD;
&#xD;
          -  Significant A or V patterns&#xD;
&#xD;
          -  Paralytic or restrictive forms of strabismus&#xD;
&#xD;
          -  History of eye surgery (strabismus or otherwise)&#xD;
      </textblock>
    </criteria>
    <gender>All</gender>
    <minimum_age>6 Months</minimum_age>
    <maximum_age>N/A</maximum_age>
    <healthy_volunteers>No</healthy_volunteers>
  </eligibility>
  <overall_official>
    <last_name>sara Alattar</last_name>
    <role>Principal Investigator</role>
    <affiliation>Assiut University</affiliation>
  </overall_official>
  <overall_contact>
    <last_name>Sara Alattar, Msc</last_name>
    <phone>01004450144</phone>
    <phone_ext>+2</phone_ext>
    <email>alattarsara@yahoo.com</email>
  </overall_contact>
  <overall_contact_backup>
    <last_name>Sara Alattar, Msc</last_name>
    <phone>01004450144</phone>
    <phone_ext>+2</phone_ext>
    <email>saraalattar@aun.edu.eg</email>
  </overall_contact_backup>
  <location>
    <facility>
      <name>Ophthalmology department, faculty of medicine, Assiut university</name>
      <address>
        <city>Assiut</city>
        <zip>71526</zip>
        <country>Egypt</country>
      </address>
    </facility>
    <contact>
      <last_name>Sara Alattar, Msc</last_name>
      <phone>+201004450144</phone>
      <email>alattarsara@yahoo.com</email>
    </contact>
    <contact_backup>
      <last_name>Mohamed Sayed Saad, PhD</last_name>
      <phone>+201001825024</phone>
      <email>mohsayedsaad@aun.edu.eg</email>
    </contact_backup>
  </location>
  <location_countries>
    <country>Egypt</country>
  </location_countries>
  <reference>
    <citation>Lueder GT, Galli M, Tychsen L, Yildirim C, Pegado V. Long-term results of botulinum toxin-augmented medial rectus recessions for large-angle infantile esotropia. Am J Ophthalmol. 2012 Mar;153(3):560-3. doi: 10.1016/j.ajo.2011.08.019. Epub 2011 Oct 13.</citation>
    <PMID>21996305</PMID>
  </reference>
  <reference>
    <citation>Vroman DT, Hutchinson AK, Saunders RA, Wilson ME. Two-muscle surgery for congenital esotropia: rate of reoperation in patients with small versus large angles of deviation. J AAPOS. 2000 Oct;4(5):267-70. doi: 10.1067/mpa.2000.106960.</citation>
    <PMID>11040475</PMID>
  </reference>
  <reference>
    <citation>Bayramlar H, Karadag R, Yildirim A, Ocal A, Sari U, Dag Y. Medium-term outcomes of three horizontal muscle surgery in large-angle infantile esotropia. J Pediatr Ophthalmol Strabismus. 2014 May-Jun;51(3):160-4. doi: 10.3928/01913913-20140318-02. Epub 2014 Mar 25.</citation>
    <PMID>24654800</PMID>
  </reference>
  <reference>
    <citation>Minkoff OV, Donahue SP. Three-muscle surgery for infantile esotropia in children younger than age 2 years. J Pediatr Ophthalmol Strabismus. 2005 May-Jun;42(3):144-8; qiuz 174-5. doi: 10.3928/01913913-20050501-01.</citation>
    <PMID>15977866</PMID>
  </reference>
  <reference>
    <citation>Khan AO. Two horizontal rectus eye muscle surgery combined with botulinum toxin for the treatment of very large angle esotropia. A pilot study. Binocul Vis Strabismus Q. 2005;20(1):15-20.</citation>
    <PMID>15828866</PMID>
  </reference>
  <reference>
    <citation>Ozkan SB, Topaloglu A, Aydin S. The role of botulinum toxin A in augmentation of the effect of recession and/or resection surgery. J AAPOS. 2006 Apr;10(2):124-7. doi: 10.1016/j.jaapos.2005.11.011.</citation>
    <PMID>16678746</PMID>
  </reference>
  <reference>
    <citation>McNeer KW, Tucker MG, Spencer RF. Botulinum toxin management of essential infantile esotropia in children. Arch Ophthalmol. 1997 Nov;115(11):1411-8. doi: 10.1001/archopht.1997.01100160581010.</citation>
    <PMID>9366672</PMID>
  </reference>
  <reference>
    <citation>Owens PL, Strominger MB, Rubin PA, Veronneau-Troutman S. Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery. J AAPOS. 1998 Jun;2(3):144-6. doi: 10.1016/s1091-8531(98)90004-0.</citation>
    <PMID>10532749</PMID>
  </reference>
  <reference>
    <citation>Minguini N, de Carvalho KM, Bosso FL, Hirata FE, Kara-Jose N. Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study. Clinics (Sao Paulo). 2012;67(3):279-82. doi: 10.6061/clinics/2012(03)13. No abstract available.</citation>
    <PMID>22473411</PMID>
  </reference>
  <verification_date>February 2021</verification_date>
  <study_first_submitted>August 26, 2017</study_first_submitted>
  <study_first_submitted_qc>August 28, 2017</study_first_submitted_qc>
  <study_first_posted type="Actual">August 30, 2017</study_first_posted>
  <last_update_submitted>February 18, 2021</last_update_submitted>
  <last_update_submitted_qc>February 18, 2021</last_update_submitted_qc>
  <last_update_posted type="Actual">February 21, 2021</last_update_posted>
  <responsible_party>
    <responsible_party_type>Principal Investigator</responsible_party_type>
    <investigator_affiliation>Assiut University</investigator_affiliation>
    <investigator_full_name>Sara Alattar, MD</investigator_full_name>
    <investigator_title>assistant lecturer</investigator_title>
  </responsible_party>
  <keyword>botulinum toxin</keyword>
  <keyword>horizontal strabismus</keyword>
  <condition_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Strabismus</mesh_term>
  </condition_browse>
  <intervention_browse>
    <!-- CAUTION:  The following MeSH terms are assigned with an imperfect algorithm            -->
    <mesh_term>Botulinum Toxins</mesh_term>
  </intervention_browse>
  <patient_data>
    <sharing_ipd>No</sharing_ipd>
  </patient_data>
  <!-- Results have not yet been posted for this study                                          -->
</clinical_study>


download date: ClinicalTrials.gov processed this data on September 20, 2023
link text: Link to the current ClinicalTrials.gov record.
url: https://clinicaltrials.gov/ct2/show/NCT03266549
org study id: Botox Horizontal Strabismus
nct id: NCT03266549
lead sponsor: 
has dmc: Yes
is fda regulated drug: No
is fda regulated device: No
Horizontal strabismus includes esotropia and exotropia where there is inward or outward
      deviation of visual axes of the eyes respectively. The most common initial treatment of
      horizontal strabismus is either bilateral rectus muscle recessions or unilateral recession
      resection surgery. For large angle deviations (>50 prism diopters [PD]), surgery on 2 muscles
      alone may not be adequate with high reoperation rates. Approaches to these patients included
      large bilateral muscle recessions, supramaximal unilateral recession resection procedure,
      three or four horizontal muscle surgery, or botulinum toxin augmented surgery.

      Botulinum toxin augmentated strabismus surgery was reported in several studies. Owens et
      al.reported successful botulinum toxin augmentation of monocular recession-resection
      surgeries in 3 large-angle exotropia patients with successful results in two of the 3
      patients. Khan reported 8 patients with > 60 PD esotropia treated with botulinum-augmented
      surgery. Six of 8 had deviations of 10 PD or less following surgery. Özkan et al used
      botulinum augmentation in a group of older patients with large angle esotropia of different
      etiologies, with a success rate of 57%. Lueder et al evaluated the long-term outcomes in
      patients with infantile esotropia. The results were good, with a 74% success rate. Based on
      historical comparisons, this technique appears equally as effective as 3- or 4-muscle surgery
      and more effective than large bilateral medial rectus recessions alone.

      Ideally, a prospective randomized study should be performed to more definitively determine
      the effectiveness of intraoperative botulinum toxin augmentation compared to surgery alone.
Strabismus is defined as inability of the two eyes to align their visual axes to a common
      object of regard. Horizontal strabismus may be in the form of esotropia or exotropia
      depending on whether the visual axes and the eyes are converging or diverging respectively.

      There are multiple surgical techniques used to treat horizontal strabismus with the main goal
      being to align the visual axes so that binocular vision may develop. The most common initial
      treatment is either bilateral rectus muscle recessions or unilateral recession resection
      surgery. For large angle deviations (>50 prism diopters [PD]), surgery on 2 muscles alone may
      not be adequate to correct the strabismus with high reoperation rates. Approaches to these
      patients have included large bilateral muscle recessions, supramaximal unilateral recession
      resection procedure, three or four horizontal muscle surgery, or botulinum toxin augmented
      surgery.

      Botulinum toxin exerts its effect by interfering with release of acetylcholine at the
      neuromuscular junction, thus inhibiting muscle contraction. Although the pharmacologic effect
      of botulinum toxin is temporary, permanent results in patients with strabismus may occur.
      These effects include a change in the length-tension curves of the muscles and permanent
      changes in sarcomere density and myosin heavy chain composition.

      Botulinum toxin alone has been advocated by McNeer and associates as a primary treatment for
      infantile esotropia in children with smaller angles of deviation. The advantage of this
      approach is that incisional surgery is not required. However, it was found that botulinum
      alone was less effective in establishing binocularity when compared to standard surgery. This
      is likely because multiple injections are often needed, which prolongs the duration of
      misalignment. On the other hand, the concomitant use of botulinum toxin and surgery allowed
      for rapid establishment of alignment. Other advantages of botulinum augmentation are that
      only 2 muscles are operated upon, thus decreasing anesthesia duration and the risk of
      surgical complications, and the lateral rectus muscles are preserved for additional surgery,
      if needed.

      Botulinum toxin augmentation of strabismus surgery was reported in several previous studies.
      Owens et al. reported the successful intraoperative use of botulinum toxin to augment
      monocular recession-resection surgeries in three large-angle exotropia patients. Two of these
      patients had orthotropia ±10 PD at their final examinations, while the third patient
      demonstrated a stable 18 PD exotropia which was cosmetically satisfactory. Khan reported 8
      patients with > 60 PD esotropia treated with botulinum-augmented horizontal muscle surgery.
      Six of 8 had deviations of 10 PD or less following surgery, with an average follow-up of 9
      months. Özkan et al. used botulinum augmentation in a group of older patients (age range 5-50
      years) with large-angle esotropia of different etiologies, with a success rate of 57% and an
      average follow-up of 14 months. Minguini et al. compared the results of surgery alone versus
      surgery plus treatment with botulinum toxin for treatment of 23 patient with large angle
      strabismus. Lueder et al. evaluated the long-term outcomes in patients with infantile
      esotropia who had been followed for more than 2 years after treatment. The results were good,
      with a 74% success rate. This study demonstrated that this procedure is an effective
      treatment for infants with large-angle infantile esotropia, with stable results over time2.
      Based on historical comparisons, it appears equally as effective as 3- or 4-muscle surgery
      and more effective than large bilateral medial rectus recessions alone.

      Ideally, a prospective randomized study should be performed to more definitively determine
      the effectiveness of the addition of intraoperative botulinum toxin compared to surgery
      alone.
allocation: Randomized
intervention model: Parallel Assignment
primary purpose: Treatment
masking: None (Open Label)
measure: success rate
time frame: Patients will be examined at 1 week after surgery
description: Outcomes will be considered successful if the patients had orthotropia ±10 PD
measure: incidence of complications
time frame: Patients will be examined at 1 week after surgery
description: ptosis vertical deviation under-correction (residual esotropia) overcorrection (consecutive exotropia)
measure: Ocular alignment
time frame: 12 months postoperative
description: Orthotropia or angle of deviation if present
arm group label: Botulinum toxin augmented surgery group
arm group type: Experimental
description: unilateral recess-resect procedure, or bilateral rectus muscle recession plus intraoperative injection of 2.5 to 5 units of botulinum toxin A into the recessed muscle.
arm group label: conventional surgery group
arm group type: Active Comparator
description: unilateral recess-resect procedure, bilateral rectus muscle recession, or 3 horizontal rectus muscle surgery according to the type of strabismus and the presence or absence of deep amblyopia.The standard correction tables will be used as a guide for the amount of muscle recession and, or resection
intervention type: Procedure
intervention name: botulinum toxin augmented surgery
description: unilateral recess-resect procedure, or bilateral rectus muscle recession plus intraoperative injection of 2.5 to 5 units of botulinum toxin A into the recessed muscle.
arm group label: Botulinum toxin augmented surgery group
intervention type: Procedure
intervention name: conventional surgery
description: unilateral recess-resect procedure, bilateral rectus muscle recession, or 3 horizontal rectus muscle surgery according to the type of strabismus and the presence or absence of deep amblyopia. The standard correction tables will be used as a guide for the amount of muscle recession and, or resection.
arm group label: conventional surgery group
criteria: 
gender: All
minimum age: 6 Months
maximum age: N/A
healthy volunteers: No
last name: sara Alattar
role: Principal Investigator
affiliation: Assiut University
last name: Sara Alattar, Msc
phone: 01004450144
phone ext: +2
email: alattarsara@yahoo.com
last name: Sara Alattar, Msc
phone: 01004450144
phone ext: +2
email: saraalattar@aun.edu.eg
facility: 
contact: 
contact backup: 
country: Egypt
citation: Lueder GT, Galli M, Tychsen L, Yildirim C, Pegado V. Long-term results of botulinum toxin-augmented medial rectus recessions for large-angle infantile esotropia. Am J Ophthalmol. 2012 Mar;153(3):560-3. doi: 10.1016/j.ajo.2011.08.019. Epub 2011 Oct 13.
PMID: 21996305
citation: Vroman DT, Hutchinson AK, Saunders RA, Wilson ME. Two-muscle surgery for congenital esotropia: rate of reoperation in patients with small versus large angles of deviation. J AAPOS. 2000 Oct;4(5):267-70. doi: 10.1067/mpa.2000.106960.
PMID: 11040475
citation: Bayramlar H, Karadag R, Yildirim A, Ocal A, Sari U, Dag Y. Medium-term outcomes of three horizontal muscle surgery in large-angle infantile esotropia. J Pediatr Ophthalmol Strabismus. 2014 May-Jun;51(3):160-4. doi: 10.3928/01913913-20140318-02. Epub 2014 Mar 25.
PMID: 24654800
citation: Minkoff OV, Donahue SP. Three-muscle surgery for infantile esotropia in children younger than age 2 years. J Pediatr Ophthalmol Strabismus. 2005 May-Jun;42(3):144-8; qiuz 174-5. doi: 10.3928/01913913-20050501-01.
PMID: 15977866
citation: Khan AO. Two horizontal rectus eye muscle surgery combined with botulinum toxin for the treatment of very large angle esotropia. A pilot study. Binocul Vis Strabismus Q. 2005;20(1):15-20.
PMID: 15828866
citation: Ozkan SB, Topaloglu A, Aydin S. The role of botulinum toxin A in augmentation of the effect of recession and/or resection surgery. J AAPOS. 2006 Apr;10(2):124-7. doi: 10.1016/j.jaapos.2005.11.011.
PMID: 16678746
citation: McNeer KW, Tucker MG, Spencer RF. Botulinum toxin management of essential infantile esotropia in children. Arch Ophthalmol. 1997 Nov;115(11):1411-8. doi: 10.1001/archopht.1997.01100160581010.
PMID: 9366672
citation: Owens PL, Strominger MB, Rubin PA, Veronneau-Troutman S. Large-angle exotropia corrected by intraoperative botulinum toxin A and monocular recession resection surgery. J AAPOS. 1998 Jun;2(3):144-6. doi: 10.1016/s1091-8531(98)90004-0.
PMID: 10532749
citation: Minguini N, de Carvalho KM, Bosso FL, Hirata FE, Kara-Jose N. Surgery with intraoperative botulinum toxin-A injection for the treatment of large-angle horizontal strabismus: a pilot study. Clinics (Sao Paulo). 2012;67(3):279-82. doi: 10.6061/clinics/2012(03)13. No abstract available.
PMID: 22473411
responsible party type: Principal Investigator
investigator affiliation: Assiut University
investigator full name: Sara Alattar, MD
investigator title: assistant lecturer
mesh term: Strabismus
mesh term: Botulinum Toxins
sharing ipd: No