The aim of this study is to investigate the changes of quality of life in patients with acute acquired comitant esotropia (AACE) before and after injection of botulinum toxin type A, and to analyze the related influencing factors.

A total of 39 patients (78 eyes) with AACE who received botulinum toxin type A injection at Beijing Tongren Hospital, Capital Medical University from January 2022 to March 2024 were enrolled, including 19 males (38 eyes) and 20 females (40 eyes) with a mean age of (23.67±13.06) years (ranging from 8 to 56 years). All patients underwent strabismus degree examination, binocular visual function examination, and completed the Amblyopia and Strabismus Quality of Life Evaluation (ASQE) questionnaire before treatment, as well as at 1, 3 and 6 months after injection. Age, strabismus degree and quality of life scores were described as ±s; gender, binocular simultaneous vision, fusion function and distant stereoscopic vision were described by case number and percentage. Generalized estimating equation was used to compare the quality of life scores, strabismus degree and binocular visual function at different time points, and Bonferroni method was adopted for post-hoc pairwise comparison. Univariate and multivariate linear regression analyses were performed to explore the influencing factors for the improvement of patients′ quality of life.

The total ASQE scores of patients were 62.92±1.51, 83.47±1.99, 82.61±2.52 and 83.31±2.54 at preoperative time, 1 month, 3 months, and 6 months postoperatively, respectively. The scores for the dimension of concern regarding the better-seeing eye at each time point were 66.26±5.64, 96.68±2.50, 88.76±3.59 and 92.71±3.66, respectively. The scores for the distance estimation dimension were 72.78±1.92, 90.14±1.80, 90.19±1.83, and 88.91±1.95, respectively. The scores for the visual disorientation dimension were 70.69±4.24, 86.71±3.34, 85.90±3.68, and 89.63±2.99, respectively. The scores for the diplopia dimension were 43.60±2.01, 72.59±3.32, 68.61±3.29, and 68.97±3.76, respectively. The scores for the social interaction and external appearance dimension were 55.87±3.53, 71.28±3.37, 75.47±3.70, and 77.74±3.85, respectively. There were significant improvements in the total and all five dimensional scores at all postoperative time points compared with the preoperative baseline (Wald χ² = 66.83, 24.58, 51.74, 15.71, 66.33, 25.18; P<0.05). The distance strabismus angles were (21.46±0.98)^△, (0.32±0.67)^△, (3.76±0.76)^△ and (4.78±1.08)^△ at each time point, respectively. The distance strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 202.21, P<0.05). The near strabismus angles were (19.68±1.06)^△, (-0.09±0.54)^△, (2.56±0.74)^△ and (3.57±1.03)^△ at each time point, respectively. The near strabismus angle was significantly decreased at all postoperative follow-up time points compared with baseline (Wald χ² = 188.61, P<0.05). The prevalence of distant stereopsis was 58.97%, 89.74%, 89.74% and 89.74% at each time point, respectively. The prevalence was significantly elevated at all postoperative time points compared with baseline (Wald χ² = 15.57, P<0.05). The near stereoacuity was (2.58±0.04)log″, (2.02±0.06)log″, (2.05±0.07)log″ and (2.06±0.07)log″ at each time point, respectively. Near stereoacuity was significantly improved at all postoperative time points compared with baseline (Wald χ² = 44.27, P<0.05). The improvement degree of quality of life was significantly correlated with lower baseline quality of life score (t=-6.32, P<0.05), lower strabismus degree at the final follow-up (t=-3.90, P<0.05), and better near stereoacuity at the final follow-up (t=-2.10, P<0.05). In addition, the improvement of quality of life in female patients was significantly lower than that in males (t=-2.52, P<0.05).

For patients with AACE, botulinum toxin type A injection can significantly reduce strabismus degree, improve stereoscopic visual function and quality of life. Female gender, higher baseline quality of life score, larger strabismus degree and poorer near stereoscopic visual function at final follow-up are independent risk factors for unsatisfactory improvement of quality of life.