To determine if the involuntary contractions of eyelids may have any effects on the development of corneal astigmatism, we performed this prospective study which includes 19 patients with either essential blepharospasm or hemifacial spasm. In hemifacial spasm, the degree of corneal astigmatism was evaluated between two eyes. Then the topographic changes were checked using vector analysis technique before and after passively opening the eyelids. They were also measured before and at 1 and 6 months after the injection of Botulinum toxin. Resultantly, 20 eyes had the with-the-rule (group1) and 9 eyes against-the-rule (group2) astigmatism. In hemifacial spasm, significantly more astigmatism was found at spastic eyes. The corneal topographic changes after passively opening the eyelids showed 10 eyes with the astigmatic shift to the with-the-rule, while the remaining 19 to the againstthe- rule. At 1 month after injection of Botulinum toxin, group 1 showed reduced average corneal astigmatism, whereas group 2 showed increased astigmatism. The astigmatic change vector showed significantly more against-the-rule. In the contrary, 6 months after treatment, corneal astigmatism again increased in group 1 and decreased in group 2. So they took on the appearance of pretreatment astigmatic status eventually. Conclusively eyelids may play an important role in corneal curvature.
Aged ; Astigmatism/*drug therapy/physiopathology ; Blepharospasm/*drug therapy/physiopathology ; Botulinum Toxin Type A/administration & dosage/*therapeutic use ; Cornea/drug effects/physiopathology ; Corneal Diseases/*drug therapy/physiopathology ; Eyelids/drug effects/physiopathology ; Female ; Humans ; Injections ; Male ; Middle Aged ; Time Factors ; Treatment Outcome

PURPOSE: To assess the clinical outcomes following botulinum neurotoxin type A (BoNT-A) treatment with an individualized injection technique based on the types of spasms and to compare the results of the individualized injection technique with those of the conventional injection technique in the same patients. METHODS: From November 2011 to July 2013, 77 BoNT-A injections were performed in 38 patients. Eighteen patients were treated with conventional BoNT-A injections before 2011, and 20 patients were referred to our hospital for unsatisfactory results after a conventional injection technique. We classified the patients by spasm-dominant sites: the lateral orbital area, representing the orbital orbicularis-dominant group (ODG); the glabella, representing the corrugator-dominant group (CDG); and the ptosis, representing the palpebral part of the orbicularis-dominant group (PDG). We increased the injection dose into the spasm-dominant sites of the blepharospasm groups. We assessed subjective symptom scores (functional disability score, FDS) after treatment. RESULTS: This study included 38 patients (26 women, 12 men; mean age, 60.6 +/- 10.9 years). There were 21 patients in the ODG, 10 patients in the CDG, and 7 patients in the PDG. Mean ages were 59.7 +/- 12.6, 59.8 +/- 8.5, and 66.8 +/- 9.0 years, and mean BoNT-A injection dose was 38.8 +/- 11.2, 38.8 +/- 11.2, and 38.8 +/- 10.8 U in each group, respectively (p = 0.44, 0.82 Kruskal-Wallis test). Mean FDS after injection was 1.7 +/- 0.7 in the ODG, 1.4 +/- 0.8 in the CDG, and 1.2 +/- 0.3 in the PDG. There were significant differences in reading and job scale among the three groups. In a comparison between the conventional and individualized injection techniques, there was a significant improvement in mean FDS and in the reading scale in the PDG with the individualized injection technique. The success rate was 92.1% in the conventional injection group and 94.1% in the individualized injection group. CONCLUSIONS: The individualized injection technique of BoNT-A according to the spasm-dominant site is an effective and safe treatment method for essential blepharospasm patients.
Aged ; Blepharospasm/*drug therapy/physiopathology ; Botulinum Toxins, Type A/*administration & dosage ; Dose-Response Relationship, Drug ; Eye Movements/*drug effects ; Female ; Follow-Up Studies ; Humans ; Injections ; Male ; Middle Aged ; Neuromuscular Agents/administration & dosage ; Oculomotor Muscles/*physiopathology ; Retrospective Studies ; Treatment Outcome

PURPOSE: To compare the efficacies and safeties of Meditoxin(R) (Medy-Tox, Korea) and Botox(R) in the treatment of essential blepharospasm. METHODS: We performed a double-blind, randomized, comparative trial comparing Meditoxin(R) and Botox(R) for treatment of blepharospasm in 60 patients from the intention-to-treat (ITT) population and 52 patients from the per-protocol (PP) population. We analyzed the improvements in severity of spasm (SS) at four weeks post-injection as a primary efficacy outcome. Changes in eyelid closing force (CF) and functional visual status (FVS) after injection were analyzed for secondary efficacy outcomes, and adverse effects were demonstrated for the safety evaluation. RESULTS: Improvement in SS was noted in 90.3% of the Meditoxin(R) group and 86.2% of the Botox(R) group. There were no significant differences between treatment groups in the changes of CF and FVS post-injection (p>0.05). Since the lower limit of the 95% confidence interval (-1.76% for ITT, -1.64% for PP) was over the -15% threshold, we determined that Meditoxin(R) was not inferior to Botox(R) in either the ITT or PP populations. Adverse effects developed in 16.1% of the Meditoxin(R) group and 27.6% of the Botox(R) group, but no serious adverse events were found in either group. CONCLUSIONS: Meditoxin(R) and Botox(R) were comparable in efficacy and safety in the treatment of essential blepharospasm.
Aged ; Blepharospasm/*drug therapy/physiopathology ; Botulinum Toxin Type A/*administration & dosage/adverse effects ; Double-Blind Method ; Female ; Humans ; Injections ; Male ; Middle Aged ; Neuromuscular Agents/*administration & dosage/adverse effects ; Treatment Outcome