130318 Inferior rectus botulinum toxin injection in vertical strabismus

capsulotomy (PPC) in children under 8 undergoing primary intraocular lens (IOL) implantation at Leeds Teaching Hospitals NHS Trust (2014-2024).We retrospectively reviewed 40 eyes from 30 patients (10 bilateral, 20 unilateral).Patients were grouped by age: <2 years (12 eyes), 2-5 years (20 eyes), and 6-8 years (8 eyes).Data collected included PPC status, intervention type, time to intervention, and complications.PPC was performed in 8/12 eyes (67%) in the <2 group, 9/20 eyes (45%) in the 2-5 group, and none in the 6-8 group.VAO intervention occurred in: 3/8 (38%) with PPC vs 3/4 (75%) without PPC in <2s.3/9 (33%) with PPC vs 8/11 (73%) without PPC in 2-5s.2/8 (25%) in 6-8s (no PPC)Intervention was surgical in 14 eyes (35%) and via YAG in 5 (13%).Median time to intervention increased with age: 7 months (<2), 15 months (2-5), 58 months (6-8).One patient developed glaucoma; two eyes required repeat procedures; no retinal detachments occurred.This reinforces previous studies showing PPC reduces VAO in children under 5. Children aged 6-8 had a lower rate of VAO and longer time to onset, even without PPC.These findings support the continued use of PPC in children under 5 and suggest a reduced need for intervention in older children.