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Background <p>To identify independent risk factors and predictors for botulinum toxin type A (BTA) reinjection within 6 months in acute acquired concomitant esotropia (AACE) patients, providing a scientific foundation for risk-stratified clinical management.</p> Methods <p>In this case-control study, AACE patients enrolled at Beijing Tongren Hospital (July 2021–January 2025) receiving initial BTA treatment were categorized into reinjection (<i>n</i> = 56) and nonreinjection (<i>n</i> = 61) groups based on the need for a second injection within 6 months. All participants underwent comprehensive ophthalmic and binocular vision assessments at baseline (T0), 1 month (T1), and 3 months (T2). Binary logistic regression analyses were performed to identify predictors.</p> Results <p>Baseline characteristics were comparable between groups, except that anisometropia (≥ 1.0 D) was significantly more prevalent in the reinjection group. Multivariable analysis revealed that baseline anisometropia (≥ 1.0 D) was an independent risk factor for reinjection (OR = 2.789, 95% CI: 1.183–6.576). Incorporating postoperative measures, the dynamic prediction model further identified residual distance deviation at 3 months (T2), measured with full refractive correction, as a significant predictor (OR = 1.315 per prism diopter increase, 95% CI: 1.069–1.619). A prediction model combining these factors achieved an area under the curve of 0.810 (95% CI: 0.732–0.887). A cutoff of &gt; 5.23 prism diopters for residual deviation at T2 predicted reinjection with 82.0% specificity.</p> Conclusions <p>Anisometropia is a robust baseline predictor for BTA reinjection in AACE. Residual distance deviation at 3 months postoperatively serves as a critical dynamic indicator of treatment response and reinjection risk, enabling early identification of high-risk patients.</p>

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Risk factors and predictors for botulinum toxin type A reinjection within six months in patients with acute acquired concomitant esotropia

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月31日

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  • Jiayu Chen,
  • Jie Hao,
  • Jiawen Liu,
  • Huijian Li,
  • Xueran Guo,
  • Zhaojun Meng,
  • Jing Fu

摘要

Background

To identify independent risk factors and predictors for botulinum toxin type A (BTA) reinjection within 6 months in acute acquired concomitant esotropia (AACE) patients, providing a scientific foundation for risk-stratified clinical management.

Methods

In this case-control study, AACE patients enrolled at Beijing Tongren Hospital (July 2021–January 2025) receiving initial BTA treatment were categorized into reinjection (n = 56) and nonreinjection (n = 61) groups based on the need for a second injection within 6 months. All participants underwent comprehensive ophthalmic and binocular vision assessments at baseline (T0), 1 month (T1), and 3 months (T2). Binary logistic regression analyses were performed to identify predictors.

Results

Baseline characteristics were comparable between groups, except that anisometropia (≥ 1.0 D) was significantly more prevalent in the reinjection group. Multivariable analysis revealed that baseline anisometropia (≥ 1.0 D) was an independent risk factor for reinjection (OR = 2.789, 95% CI: 1.183–6.576). Incorporating postoperative measures, the dynamic prediction model further identified residual distance deviation at 3 months (T2), measured with full refractive correction, as a significant predictor (OR = 1.315 per prism diopter increase, 95% CI: 1.069–1.619). A prediction model combining these factors achieved an area under the curve of 0.810 (95% CI: 0.732–0.887). A cutoff of > 5.23 prism diopters for residual deviation at T2 predicted reinjection with 82.0% specificity.

Conclusions

Anisometropia is a robust baseline predictor for BTA reinjection in AACE. Residual distance deviation at 3 months postoperatively serves as a critical dynamic indicator of treatment response and reinjection risk, enabling early identification of high-risk patients.