A comparison of facial muscle squeezing versus non-facial muscle squeezing on the efficacy of botulinumtoxin-A injections for the treatment of facial dystonia

BACKGROUND

This study was performed to address whether voluntary muscle squeezing post botulinum toxin-A treatment with increased neuronal activity translates into noticeable patient benefit in practice.

METHODS

This was a prospective, consecutive, double crossover interventional study. Participants were receiving regular (3 monthly) botulinum toxin-A treatment for aberrant facial nerve regeneration (AFNR), benign essential blepharospasm (BEB) or hemifacial spasm (HFS). Twenty-six participants were recruited and these were randomised into two groups (A and B). Group A performed a program of intensive facial exercises for 5 minutes after their first and third treatment whereas after their second treatment, they were asked to rest in a seated position for 5 minutes, and instructed not to talk or perform any voluntary movements of their face. Conversely group B were only asked to perform squeezing exercises after their second treatment. Outcomes were evaluated objectively using video-recordings and subjectively by questionnaire and telephone interview of participants.

RESULTS

Video-recording data was complete for 21 participants. There was a mean 40% reduction in the frequency of facial muscle spasms and a 33% lower severity score (video-recordings graded by 1 masked investigator) where intensive facial exercises were performed post-treatment. These findings did not reach statistical significance (Mann- Whitney two-tailed test; p = 0.367).

CONCLUSION

Although statistical significance was not achievable, this study suggested a possible trend towards an increased efficacy of botulinum toxin-A, with facial muscle squeezing post BTX treatment. Future studies with a larger number and a better defined subset of subjects may lead to statistical significance.

Transconjunctival sutureless vitrectomy: initial experience and surgical tips

OBJECTIVES

We report the operative details and surgical outcomes of 39 consecutive transconjunctival sutureless vitrectomies using the TSV 25 system.

METHODS

We retrospectively reviewed the medical records of 35 patients (39 eyes) who underwent surgery using TSV 25 at the Department of Ophthalmology, Waterford Regional Hospital between March 2003 and February 2005. Preoperative, intraoperative and postoperative details were recorded and analysed. We also performed a systematic review of our surgical technique.

RESULTS

Mean (+/-SD; range) duration of surgery was 32.85 (17.54; 5-85) min. Methods of anaesthesia included retrobulbar anaesthesia (31; 79.5%) and general anaesthesia (8; 20.5%). The mean (+/-SD; range) length of stay was 1.53 (1.25; 0-4) days. Mean (+/-SD; range) visual acuities (logMAR) were -1.335 (1.15; 0.0 to -3.0) and -0.803 (1.03; 0.1 to -3.0) preoperatively and postoperatively, respectively. The mean (+/-SD) intraocular pressures were 14.69 (4.64) mmHg and 11.56 (9.03) mmHg preoperatively and at the first dressing, respectively. Intraoperative complications included blockage of the TSV cutter tip during attempted clearance of organized intragel haemorrhage, thus requiring conversion to conventional trans pars plana vitrectomy (1; 2.6%). No other intraoperative complication arose. Complications in the postoperative period included: reactivation of dormant chorioretinal toxoplasmosis (1; 2.6%); postoperative posterior segment haemorrhage (3; 7.7%); hyphaema (1; 2.6%); transient postoperative hypotony (10; 25.6%).

CONCLUSIONS

With appropriate case selection, and with appreciation of this technique's limitations, transconjunctival sutureless vitrectomy is a safe procedure.