[Safety and efficacy of botulinum toxin in hemifacial spasm]. / Efficacité et tolérance de la toxine botulique dans l'hémispasme facial.

UNLABELLED: Given the failure of pharmacologic and surgical treatment in the management of hemifacial spasm, the use of botulinum toxin as first line therapy is interesting. PURPOSE: To evaluate the safety and efficacy of type A botulinum toxin in the treatment of hemifacial spasm. PATIENTS AND METHODS: We conducted a retrospective, descriptive and comparative study of 25 patients with hemifacial spasm followed in the ophthalmology department of Habib Thameur hospital in Tunis over the period from June 2003 to June 2009. All patients received injections of botulinum toxin type A (Botox). RESULTS: We carried out 168 Botulinum A toxin injections (Botox) with an average of 6.85 ± 4.32 injections per patient. Doses varied between 12.5 U and 28 U Botox. A good response to treatment was observed in 92% of patients with a satisfactory return to daily activities and work. Based on a subjective scale from 1 to 3, the average total functional benefit was 2.55 ± 0.56. Average total duration of therapeutic response was 9.35 ± 3.64 weeks. Local side effects observed were comparable to those described in the literature: ptosis (32.4%), diplopia (8.2%), drooping of the labial commissure (11.2%), lagophthalmos (21.3%), tearing (7%), dry eye (4%). No systemic complication was noted. CONCLUSION: Botulinum toxin type A provides effective short-term and medium-term results in the treatment of hemifacial spasm. It is well tolerated locally and systemically. This safety and efficacy make it a valuable therapeutic alternative in the management of hemifacial spasm.

[Contribution of the cryosurgery in the management of xeroderma pigmentosum]. / L'apport de la cryochirurgie dans la prise en charge du xeroderma pigmentosum.

BACKGROUND: Basal cell carcinoma (BCC) occurs frequently in young patients with xeroderma pigmentosum (XP). Because tumours are multiple and usually found on the face, alternatives to surgery are proposed. The purpose of this study was to evaluate the efficacy of cryosurgery for BCC in XP patients. PATIENTS AND METHODS: This was a retrospective study that included all instances of BCC occurring in XP patients treated by cryosurgery between January 2002 and October 2008. RESULTS: Forty-five cases of primary facial BCC and one case of relapsing BCC (16 on the cheeks, 11 on the nose, six on the face and five on the inner edge of the eye area) were treated by cryosurgery in 18 XP patients (average age: 18.7 years; sex ratio: 0.5). Mean carcinoma size was 10mm. Thirty-six tumours were nodular and 10 were nodular and ulcerated. Follow-up ranged from 16 to 60 months (mean: 30 months). Complications were rare. Cosmetic results were satisfactory. We noted 10 cases of hypopigmentation (21.7%) and one notch on the nose following treatment for recurrent BCC on a radiotherapy scar. Relapse occurred in one case (2.17%). CONCLUSION: Because of its simplicity, its good safety, its sparing of skin and its reliability of oncological outcome, cryosurgery is the treatment of choice for CBC in XP patients.

[Subretinal neovascularization in angioid streaks]. / Néovascularisation sous rétinienne au cours des stries angioïdes.

Angoid streaks are linear crack-line dehiscences of Bruch's membrane. Choroidal neovascularization is the most serious complication of angioid streaks. The authors try to determine the incidence of neovascular macular degeneration in angioid streaks, their detection and treatment. A retrospective study of 26 eyes of 13 patients with angioid streaks was performed, 6 of whom had macular complications and 3 had subretinal neovascular membranes. Indocyanine green angiography is an adjunctive diagnostic tool in the detection of subretinal neovascular membranes in angioid streaks. Laser photocoagulation of choroidal neovascularization in angioid streaks may end the choroidal neovascularization and help stabilize visual acuity.