Success rates of botulinum toxin in different types of strabismus and dose effect.

OBJECTIVE: To determine the effect of botulinum toxin in different types of strabismus and analyze its dose effect. DESIGN: This was an interventional clinical study performed in a tertiary care university hospital. METHODS: Eighty six patients treated with botulinum toxin for strabismus were included. Main outcome measures involved success of botulinum toxin, alignment change per unit of toxin, and dose effect on complications and outcomes. RESULTS: Success rates were 31% for infantile esotropia, 25% for partially accommodative esotropia, 61.5% for residual esotropia, 25% for third cranial nerve paralysis, 13.3% for sixth cranial nerve paralysis, 75% for Duane retraction syndrome, and 38.5% for nonaccomodative esotropia. Improvement in deviation size after botulinum toxin treatment was significant in patients with infantile esotropia (p = 0.001), residual esotropia (p = 0.001), and nonaccomodative esotropia (p = 0.03). Mean deviation change per 1 unit of toxin was 2.7 ± 2.4 prism diopters (PD) with a single injection and 2.1 ± 1.9 PD with multiple injections. A 3.32 PD of early deviation change with botulinum toxin corrected 1 PD of final deviation. Success rate was not correlated with age (r = 0.040, p = 0.8), sex (r = -0.083, p = 0.6), mean dose (r = -0.149, p = 0.35), or total dose (r = 0.165, p = 0.29) but was significantly correlated with deviation size (ß = -0.077, p = 0.0001). Complications were not associated with the dose of botulinum toxin (p > 0.05). CONCLUSIONS: Botulinum toxin has variable outcomes in different types of strabismus. Still, it reduces the deviation size in most patients, thus allowing for a smaller amount of subsequent muscle surgery. Early overcorrection is a more powerful indicator of better outcome than postinjection duction deficit.

Acute Effects of Coffee on Peripapillary and Subfoveal Choroidal Parameters in Young Healthy Subjects.

PURPOSE: To evaluate the acute effects of coffee on peripapillary and subfoveal choroidal structures using spectral-domain optical coherence tomography (SD-OCT). MATERIALS AND METHODS: A total of 28 healthy individuals (study group) and 28 healthy controls were enrolled in this study. The peripapillary and subfoveal choroidal thickness (SFCT) was measured at baseline, 30 min, 1 h, 2 h, and 4 h, following coffee (75 mg caffeine/200 ml) intake in the study group and the same amount of water in the control group. Choroidal images were binarized to the luminal area (LA), stromal area (SA), and total choroidal area (TCA) using ImageJ software. Similar to the CT, the peripapillary and subfoveal choroidal vascularity indices (CVIs) were calculated at the same time points in both groups. RESULTS: CT and CVI measurements of four peripapillary quadrants displayed no significant difference at baseline and all-time points in both groups (p > 0.05). In the study group, SFCT was found to be significantly lower (at 30 min, 1 h, 2 h, and 4 h) than the baseline measurement (p < 0.05). Additionally, subfoveal LA, TCA, and CVI decreased in all-time points compared with baseline measurements (p < 0.05, for all). This was not true for the subfoveal SA (p > 0.05). No significant difference was found between the respective SFCT and subfoveal CVI measurements in the control group (p > 0.05, for all). CONCLUSION: Our study revealed that peripapillary choroidal thickness and CVI did not change following a cup of coffee intake, while subfoveal CT, LA, TCA, and CVI significantly decreased for at least 4 h.