Background/aims This study aims to evaluate the clinical efficacy of botulinum toxin type A (BTXA) injection and augmented-dosed surgery in the treatment of acute acquired concomitant esotropia (AACE), and explore potential risk factors associated with recurrence. Methods A total of 104 patients diagnosed with AACE between October 2020 and January 2021 were included and voluntarily chose to undergo augmented surgery or BTXA injection. The follow-up assessments ended in November 2022. Multivariable linear regression analysis was used to identify potential factors that influence the dose-response of bilateral medial rectus recession (MRrec). Kaplan-Meier survival analyses and Cox proportional hazards models were performed to evaluate rate and risk factors for AACE relapse. Results A total of 31 AACE patients chose augmented-dosed esotropia surgery, and 73 chose BTXA treatment. During the 2-year follow-up, the surgical group achieved more stable postoperative results with no recurrence of diplopia, while only 68.68% (95% CI 55.31% to 78.79%) patients achieved orthophoria in the BTXA group. For patients undergoing BTXA treatment, hours of near work per day were demonstrated to be a significant risk factor for AACE relapse (HR 1.29, 95% CI 1.00 to 1.67). The dose-response of augmented-dosed bilateral MRrec was positively correlated with preoperative deviation angle (R2=0.833; β=0.043, 95% CI 0.031 to 0.055; p<0.001). Conclusion Our findings provided quantitative evidence that augmented-dosed surgery would achieve more stable and favourable surgical outcomes for AACE patients compared with BTXA injection. However, BTXA treatment is still proposed for patients with small deviation angles due to its advantages of reduced trauma, operational simplicity, low cost and quick recovery. Data are available on reasonable request.

中文翻译：

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加大剂量手术与 A 型肉毒毒素注射治疗急性获得性内斜视的疗效：2 年随访


背景/目的本研究旨在评估A型肉毒毒素（BTXA）注射和加大剂量手术治疗急性获得性伴随性内斜视（AACE）的临床疗效，并探讨与复发相关的潜在危险因素。方法 纳入2020年10月至2021年1月期间确诊为AACE并自愿选择接受增强手术或BTXA注射的患者104例。随访评估于2022年11月结束。采用多变量线性回归分析来确定影响双侧内直肌衰退（MRrec）剂量反应的潜在因素。进行 Kaplan-Meier 生存分析和 Cox 比例风险模型来评估 AACE 复发率和危险因素。结果共有31例AACE患者选择加大剂量内斜视手术，73例选择BTXA治疗。在2年的随访过程中，手术组术后效果更加稳定，没有出现复视复发，而BTXA组只有68.68%（95% CI 55.31% to 78.79%）的患者实现了正视。对于接受 BTXA 治疗的患者，每天近距离工作时间被证明是 AACE 复发的重要危险因素（HR 1.29，95% CI 1.00 至 1.67）。双侧MRrec增强剂量的剂量反应与术前偏角呈正相关（R2=0.833；β=0.043，95% CI 0.031至0.055；p<0.001）。结论 我们的研究结果提供了定量证据，表明与 BTXA 注射相比，加大剂量手术将为 AACE 患者带来更稳定、更有利的手术结果。 但BTXA治疗因其创伤小、操作简单、费用低、恢复快等优点，仍被建议用于小偏角的患者。可根据合理要求提供数据。