SynthesisFrontiers in pharmacology2026
Comparative efficacy of botulinum toxin and surgical treatment for acute acquired concomitant esotropia: a systematic review and meta-analysis.
Synthesis in Frontiers in pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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5 authors.
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Abstract
Objectives: This meta-analysis aimed to compare the efficacy of botulinum toxin (BTX) injection versus surgery for acute acquired concomitant esotropia (AACE). Methods: PubMed, Embase, Web of Science, China Biomedical Sinomed, and the Cochrane Library were systematically searched for studies comparing BTX and surgery in AACE. The primary outcome was motor success rate, and secondary outcomes included stereopsis recovery and incidence of permanent exotropia. Random-effects models were applied. Sensitivity analyses, subgroup analyses, meta-regression, and publication bias assessment were performed. Results: Fourteen studies involving 1027 patients were included. At 6 months, motor success rates did not differ significantly between BTX and surgery (OR 0.45, 95% CI: 0.20-1.03, P = 0.06); however, this result was sensitive to the inclusion of a single study, and exclusion of this study favored surgery (OR 0.36, 95% CI: 0.17-0.77, P = 0.008). Subgroup analyses showed that comparable outcomes were observed between BTX and surgery in pediatric patients (OR 1.14, 95% CI: 0.45-2.89, P = 0.78) and in studies using bilateral medial rectus injection (OR 0.98, 95%CI: 0.35-2.70, P = 0.97), with stable sensitivity analyses in both subgroups. Stereopsis recovery at 6 months was similar between the two treatments (near: OR 0.61, 95% CI: 0.32-1.19, P = 0.15; distance: OR 1.05, 95%CI: 0.42-2.61, P = 0.92). Conclusion: The pooled short-term motor outcome showed substantial heterogeneity and sensitivity to individual studies. More consistent findings were observed in pediatric populations and in studies using bilateral medial rectus injections, where BTX may achieve short-term outcomes comparable to surgery. Stereopsis recovery at 6 months was also similar between the two treatments. However, given the limited number of available studies and the predominance of retrospective designs, adequately powered RCTs and prospective studies are needed to establish more definitive conclusions. Systematic Review Registration: Identifier: CRD420245127395.
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