ABSTRACT
Botulinum toxin A injection is a safe alternative procedure to surgery in the management of different types of strabismus. Serious complications such as globe perforation are rare in expert hands. The authors report a case of a child known to have a muscle-eye-brain disease with high myopia who developed endophthalmitis following inadvertent penetrating intraocular botulinum toxin A injection for strabismus correction. To their knowledge, this serious complication after penetrating botulinum toxin A injection has not been previously reported. [J Pediatr Ophthalmol Strabismus. 2023;60(2):e8-e10.].
Subject(s)
Botulinum Toxins, Type A , Strabismus , Walker-Warburg Syndrome , Humans , Male , Infant , Intraocular Pressure , Endophthalmitis/diagnosis , Endophthalmitis/etiology , Botulinum Toxins, Type A/administration & dosage , Botulinum Toxins, Type A/adverse effects , Administration, Ophthalmic , Eye Injuries, Penetrating , Walker-Warburg Syndrome/complicationsABSTRACT
Background Acute care surgery (ACS) is a novel model for the provision of emergency general surgery (GS) care. Investigating the impact of the ACS team on the management of acute emergencies can help in establishing proper management measures and improving patient care in an emergency setting. The study aims to compare the performance indicators and patient outcomes such as hospital length of stay (LOS), time to diagnosis, and operation before and after the implementation of the acute care system. Methods The study reviewed two retrospective cohorts: the pre-ACS system (n = 202) from January 2012 to December 2013 and the post-ACS system (n = 188) from January 2014 to December 2015, which were done in a tertiary care center. All adult patients diagnosed with acute appendicitis and cholecystitis requiring emergency surgery were included. Results There was an improvement in the time interval between GS referral to the diagnosis of acute appendicitis and cholecystitis (p = 0.07) and from diagnosis to the start of the operation (p = 0.38). Patients in the post-ACS model had a shorter hospital stay than the pre-ACS model patients with [M = 3.69 SD(3.18) days versus M = 3.57 SD (3.60) days, p = 0.25]. Time from the emergency department arrival to GS referral did not show an improvement [M = 4.36 SD(3.34)] hours in the pre-ACS model versus [M = 4.53 SD(3.98)] hours in the ACS model, p = 0.86). Conclusion The ACS model led to earlier diagnosis of acute appendectomy and cholecystectomy cases and reduced the LOS. The introduction of the ACS model in Saudi Arabia showed improvement in patient care during acute emergencies. Further studies including multiple centers with larger sample sizes and longer review periods are needed to evaluate the efficiency and cost-effectiveness of the ACS model.
