Comparison of Botulinum Toxin A Injection and Bridge Faden Operation Performed With Bimedial Rectus Recession in Patients With Large-Angle Esotropia

Purpose To compare the results of botulinum toxin A injection and bridge Faden operation performed with bimedial rectus recession in the treatment of large-angle esotropia. Methods The medical charts of patients with large-angle esotropia who underwent bimedial rectus recession combined with the Faden operation or botulinum toxin A injection between January 2018 and March 2022 were retrospectively screened. The degree of deviations measured before surgery and at 1, 3, 6, and 12 months after surgery were compared between the two groups. Results The sample consisted of 26 patients, of whom 15 (57.7%) were male and 11 (42.3%) were female. In the botulinum toxin A group (n = 11), the mean age was 42.1 ± 22.6 months at admission and 65.3 ± 17.1 months at surgery, and the mean preoperative near and far distance deviations were 49.8 ± 8.4 and 44.3 ± 9.4 PD, respectively. In the Faden group (n = 15), the mean age was 54.9 ± 21.7 months at admission and 71.3 ± 12.6 months at surgery, and the mean preoperative deviations at near and far distances were 49.3 ± 11.2 and 44.3 ± 9.2 PD, respectively. The complete success rates of the botulinum toxin A and Faden groups evaluated 12 months after treatment were 63.6% and 66.7%, respectively, for the near distance deviation and 72.7% and 73.3%, respectively, for the far distance deviation. After the botulinum toxin A injection, 2 patients developed transient ptosis and 1 developed consecutive exotropia. Conclusions As an alternative to multi-muscle surgery in large-angle esotropia, botulinum toxin A injection and Faden procedures, performed with bilateral medial rectus recession, provide successful results. [ J Pediatr Ophthalmol Strabismus . 2025;62(2):128–134.]