Treatment of Infantile Esotropia - Comparison Between Botulinum Toxin A and Bilateral Medial Rectus Recession.

Objectives: The objective of the study is to evaluate the examination findings, treatment methods, and follow-up results of children diagnosed with infantile esotropia (IE) and to compare botulinum toxin A (BTA) and bilateral medial rectus (MR) recession surgery. Methods: We retrospectively reviewed the medical records of patients who were diagnosed with IE. The age of the patient and the angle of deviation were taken into account to determine the treatment. Patients who underwent bilateral MR recession surgery and BTA injection were analyzed and the BTA and surgical groups were compared. Successful correction was defined as orthotropia and a deviation of up to 10 prism diopters (PD) after one surgical procedure or 1-3 botulinum injections. Results: Two hundred and forty-six patients with esotropia were included in the study. Twelve were followed up with refractive correction only. BTA injection was administered to 110 patients, while 124 patients underwent bilateral MR recession. The age of the patients ranged from three to 39 months. Patients were followed for at least 6 months, with a mean follow-up of 24.3 months in the BTA group and 21.7 months in the surgical group (p=0.23). The mean pre-treatment angle deviation was 38.9 PD in the BTA group and 40.1 PD in the surgical group (p=0.62). The success rate for patients with more than 30 PD of deviation was 72% in the surgical group compared to 36% in the BTA group (p<0.001). No statistically significant difference in success rate was observed in patients with deviations <30 PD (surgery 62%, BTA 55%, p=0.26). Conclusion: Surgical treatment of IE was more successful than BTA injection in patients with large angle deviations (>30 PD). BTA injection can be considered as an alternative to surgery in cases of small to moderate angle deviations (<30 PD).

Comparison of Accelerated Corneal Collagen Cross-linking Types for Treating Keratoconus.

PURPOSE: To compare the results of different protocols for accelerated corneal collagen cross-linking (CXL) in patients with progressive keratoconus. MATERIALS AND METHOD: This prospective comparative study involved 40 patients treated with intended UV-A radiance of 5.4 J/cm2 in 74 eyes (Group 1) and 42 patients treated with radiance of 7.2 J/cm2 in 72 eyes (Group 2). Visual acuity, subjective manifest refraction and corneal topography were analyzed before and 12 months after surgery in both groups. Postoperative complications were also noted. The results of the two protocols were statistically compared. RESULTS: There were no statistically significant differences between the groups in uncorrected distance visual acuity, corrected distance visual acuity or corneal topography pre- or postoperatively. The differences in keratometric readings (K apex, SimK1 and SimK2) and refractive results were not significant. CONCLUSION: The application of total intended UV-A radiance of 5.4 J/cm2 or 7.2 J/cm2 for accelerated CXL in patients with progressive keratoconus resulted in similar refractive and topographic outcomes.

Topographic and biomechanical evaluation of corneas in patients with ocular rosacea.

PURPOSE: To compare the topographic and biomechanical properties of corneas in the eyes of patients with ocular rosacea (OR) with those of healthy individuals. METHODS: Thirty-four healthy individuals (control group) and 34 patients with OR (study group) were evaluated in this study. Topographic measurements including keratometry values, irregularity, and surface asymmetry index in the right eye of each participant were obtained using a Scheimpflug camera with a Placido disc topographer (Sirius). Corneal hysteresis (CH), corneal resistance factor (CRF), corneal-compensated intraocular pressure (IOP), and Goldmann-related IOP were measured using the Reichert Ocular Response Analyzer. Central corneal thickness was also measured using ultrasonic pachymetry and the Sirius corneal topography system. RESULTS: Topographic parameters were not significantly different between the groups (P > 0.05). Mean CH and CRF were significantly lower in patients with OR (P = 0.003 and 0.001, respectively). Central corneal thickness was significantly lower in patients with OR compared with healthy controls (P < 0.001). Mean Goldmann-related IOP and corneal-compensated IOP were not significantly different between the groups (P = 0.09 and 0.13, respectively). CONCLUSIONS: This study demonstrated that although the eyes of patients with OR had corneal topographic findings similar to those of healthy controls, corneal biomechanical measurements (CH and CRF) were significantly lower in patients with OR. These results need to be considered when planning corneal refractive surgery in patients with OR.