Botulinum toxin type A(HSM)

To assess and compare the 2-year follow-up efficacy of botulinum toxin type A (BTXA) in the treatment of acute acquired comitant esotropia (AACE) across five age groups.

Retrospective clinical cohort study.

A total of 276 patients with AACE who received BTXA injections were enrolled from a single institution between January 2019 and January 2023 (Notably, surgery was recommended for patients >12 years with large-angle esotropia (>50 prism diopters) to reduce failure or recurrence risk). Patients were stratified into five age groups based on intervention age: ≤6 years, >6 to ≤12 years, >12 to ≤20 years, >20 to ≤30 years, and >30 years. The primary outcomes included the cumulative motor and sensory success rates across different age groups, as well as the hazard ratio (HR) for the risk of AACE relapse.

The median age of the 276 participants was 18 years (interquartile range: 9-30 years), with 125 (45.29%) being female. The overall 2-year motor success rate of BTXA for AACE treatment was 69.03% (95% confidence interval [CI]: 62.30%-74.81%). Notably, the motor success rate exhibited a tendency to decline with age, and patients older than 30 years showed significantly lower motor success rate compared to other age groups (≤6 years: 86.53%, >6-≤12 years: 79.96%, >12-≤20 years: 74.08%, >20-≤30 years: 67.45%, >30 years: 44.29%, Bonferroni-corrected posthoc test: P < .05/4). Similarly, patients aged >30 years demonstrated significantly lower rates of stereopsis recovery post-treatment compared to younger cohorts (Bonferroni-corrected posthoc test: P < .05/4). Furthermore, hours of near-work per day (HR: 1.09, 95% CI: 1.01-1.17) and age (HR: 1.04, 95% CI: 1.02-1.06) were identified as significant risk factors for AACE relapse following BTXA injection.

In this retrospective cohort study, our findings demonstrated that younger AACE patients (≤30 years) exhibited significantly greater treatment stability and success rates following BTXA injection therapy. Postoperative preservation or achievement of normal stereopsis can serve as a reliable predictor of reduced recurrence risk.

The role of botulinum toxin type A (BoNTA) in scar prevention has been studied mainly in facial and cervical regions, but its effects on extrafacial scars remain unclear. This study evaluated BoNTA's impact on scar aesthetics and its potential modulation of the NLRP3 inflammasome in wounds on the back.

A prospective, double-blind, randomized controlled trial was conducted with 23 participants undergoing fusiform excision of benign skin lesions. The treatment group received intradermal BoNTA injections immediately after suturing, while the control group received saline. Scar outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and histologic analysis, including NLRP3 expression, at 6 months postsurgery.

No significant differences were found in the POSAS observer subscale scores between groups. However, the treatment group reported lower scar-related itching (p = .018) in the POSAS patient subscale. NLRP3 expression increased in both groups over time (p < .001), but no significant difference was observed between them.

Botulinum toxin type A did not significantly improve extrafacial scar aesthetics or reduce NLRP3 expression. However, it was associated with decreased scar-related pruritus. Further research is needed to elucidate BoNTA's potential anti-inflammatory effects on wound healing.