Treatment Effects of Botulinum Toxin Injection and Acupuncture on Blepharospasm Assessed by the Change in Lower Eyelid Tension.

Objective: To investigate the treatment effects of botulinum toxin-A (BTA) injection and acupuncture on blepharospasm (BP) evaluated by the change in lower eyelid tension (LET). Methods: A series of 30 patients (male: 8, female: 22) aged between 37 and 83 years (63.80 ± 10.96 yrs) who met the eligibility criteria of BP were recruited in this study, who were randomly assigned to BTA injection group (BTA group, n = 15) and acupuncture treatment group (Acupuncture group, n = 15). BTA injections were administered to the patients in BTA group while patients in acupuncture group received the acupuncture treatment. The LET was measured by a tensiometer in both groups at baseline and at post-treatment. Results: A significant decrease in LETs over 8 weeks was found in acupuncture group (812.76 ± 193.95 Pa at baseline, 549.69 ± 150.04 Pa at 4 weeks, and 510.96 ± 150.66 Pa at 8weeks, respectively; F = 31.127, p << 0.001). There was a significant decrease in LET from 858.61 ± 190.54 Pa at baseline to 414.45 ± 63.38 Pa at 2 weeks after treatment (Z = -4.542, p << 0.01) in BTA group. At the endpoint of the study, a significant difference in LET was found between the acupuncture group (301.80 ± 181.77 Pa) and the BTA group (444.16 ± 193.44 Pa) (t = -2.077, p = 0.047). Conclusions: BP patients have an increased LET. Both BTA and acupuncture are effective in decreasing the LET. Close monitoring of LET holds promise in planning the treatment strategy for Blepharospasm.

Effect of long-term topical latanoprost medication on conjunctival thickness in patients with glaucoma.

AIM: To investigate the effect of long-term use of topically administered latanoprost on conjunctival thickness (CT) and conjunctival epithelium thickness (CET) in the patients with glaucoma. METHODS: A series of 106 glaucomatous patients were included. Of the 106 eyes, 55 eyes were treated with latanoprost eye drops once a day (latanoprost group), while 51 eyes were treated with carteolol hydrochloride eye drops (carteolol group). All the included patients completed a 2-year follow-up. CT and CET were measured with optical coherence tomography (OCT) in all patients at presentation and at 2-year visit, respectively. Statistical analysis was then performed to compare the change in CT and CET. RESULTS: At presentation, there was no difference in CET (t=0.400, P=0.689) or CT (t=1.14, P=0.259) between the two groups. No significant difference was found in CET (61.65±5.35 µm at baseline, 60.36±6.36 µm at 2-year follow-up, respectively; t=1.977, P=0.0531), while there was a significant decrease in CT from 201.45±14.99 µm at baseline to 167.81±14.57 µm at 2-year visit (t=14.1407, P<0.001) in the latanoprost group. At 2-year follow-up, no statistically difference was found in CET (62.24±5.27 µm; t=1.086, P=0.282) or CT (201.23±12.45 µm; t=1.44, P=0.154) compared to it at baseline (CET: 61.23±5.42 µm; CT: 198.76±13.68 µm, respectively) in the carteolol group. CONCLUSION: A significant decrease in conjunctival thickness is found in glaucoma patients treated with long-term topical latanoprost; its potential effect on the outcome of filtration surgery should be considered.

The palpebral conjunctival epithelium thickness in young adults measured by optical coherence tomography.

OBJECTIVE: To measure the palpebral conjunctival epithelium thickness in young adults with optical coherence tomography (OCT). METHODS: A Cirrus HD-OCT 4000 system was used to image the superior palpebral conjunctival with the Anterior Segment 5 Line Raster scanning protocol at the central region in 36 male and 26 female subjects aged between 20 and 30 years of age with normal, healthy eyes. The palpebral conjunctival epithelium thickness was measured according to the difference in brightness on OCT between the epithelium and its underlying substantia propria. The measurements were respectively performed in the same subjects by two operators and the Bland-Altman plot and intraclass correlation coefficient (ICC) were used to measure the agreement between two operators. RESULTS: No difference in the palpebral conjunctival epithelium thickness was found between the males (34.00±5.78 µm) and females (33.67±4.51 µm) (t=0.2425, p=0.8095). The mean values of the superior palpebral conjunctival epithelium thickness from operator 1 and operator 2 were 33.81±5.04 µm and 34.74±4.28 µm, respectively. The analysis of inter-operator variability demonstrated a good agreement between two operators: ICC=0.944, F=17.787, p<0.001; on the Bland-Altman plot, the 95% limits included 100% of differences between the two operators and the maximal difference is 5 µm. CONCLUSION: The palpebral conjunctival epithelium thickness can be measured using OCT with a good repeatability.