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Objective: To study the efficacy, desirable and undesirable effects of locally injectable preparation of botulinum toxin in patients suffering from Benign Essential Blepharospasm (BEB). Methods: It was a prospective study carried out from October 2006 till November 2012 at a private set up, “Dr Shakaib’s Eye Clinic”, in Islamabad. Follow up of Seventeen patients of BEB has been done over six years period after injecting botulinum toxin. The patients had been explained about the study and informed consent was taken. After taking all the standard precautions for botulinum toxin injection, 5 to 7 (mean 6) sites for injecting 1.5 to 2.0 IU of the toxin were selected depending upon the severity and duration of the problem. These patients were requested to attend the clinic regularly, initially after three days and then weekly for two weeks, followed by every month for three months and then at three monthly intervals for up to six years. Results: The useful effects of the injection appeared in all the patients within 48 hours. There were minor side effects like irritation in the eyes and heaviness in the brow region. One (5.88 %) patient developed mild ptosis, which subsided over two weeks. Four (23.52 %) patients felt almost cured after three to four repetitions of injections. The useful effect of the injection lasted for about three months in all the patients. Conclusion: Botulinum toxin is a useful remedy for Benign Essential Blepharospasm (BEB), although the effects are short term and repeated applications are required which is quite costly for the patient.

Purpose. To compare safety and efficacy between a low-cost glaucoma drainage device (GDD), the Aurolab aqueous drainage implant (AADI), and the Baerveldt glaucoma implant (BGI) in refractory childhood glaucoma in Egypt. Methods. This is a retrospective study of patients who received either an AADI or BGI at a tertiary care postgraduate teaching institute. Children aged <16 years with uncontrolled intraocular pressure (IOP) with or without prior failed trabeculectomy who completed a minimum 6-month follow-up were included. The outcome measures were IOP reduction from preoperative values and postoperative complications. Results. Charts of 57 children (younger than 16 years old) diagnosed with refractory childhood glaucoma were included. Of these, 27 eyes received AADI implants (group A), while 30 received BGI implants (group B). The mean preoperative baseline IOP was 34 ± 5 mmHg in group A versus 29 ± 2 mmHg in group B (p=0.78) in patients on maximum allowed glaucoma medications. In group A versus group B, the mean IOP decreased to 13.25 ± 8.74 mmHg (p=0.6), 12.8 ± 5.4 mmHg (p=0.7), and 12.6 ± 5.6 mmHg (p=0.9) after 1 week, 3 months, and 6 months, respectively. However, in group A, an anterior chamber reaction appeared around the tube in 14 cases starting from the first month and resolved with treatment in only 4 cases. In the other 10 cases, the reaction became more severe and required surgical intervention. This complication was not observed in any eye in group B. Conclusion. AADI, a low-cost glaucoma implant, is effective in lowering IOP in patients with recalcitrant paediatric glaucoma. However, an intense inflammatory reaction with serious consequences developed in some of our patients; we believe these events are related to the valve material. We therefore strongly recommend against its use in children.

One hundred fifty-one unilateral cataract patients were randomly assigned to receive either a one-piece Staar AA-4203 silicone intraocular lens inserted through a 3.5 mm incision, an loptex 5 mm x 6 mm oval optic lens inserted through a 5.5 mm incision, or an AMO three-piece modified C-loop 6.0 round optic poly(methyl methacrylate) lens inserted through a 6.5 mm incision. Follow-up was 97% at two days postoperatively and 84% at one week and two months postoperatively. At one week postoperatively, 62% of 3.5 mm incision cases had uncorrected visual acuity of 20/40 or better compared with 33% of 5.5 mm (P < .01) and 43% of 6.5 mm incision cases. At two months postoperatively, 85% of 3.5 mm incision cases had uncorrected visual acuity of 20/40 or better compared with 64% of 6.5 mm (P < .05) and 71% of 5.5 mm incision cases. The 3.5 mm incision cases had significantly less total keratometric cylinder than other cases at all postoperative examinations (P < or = .001) and less surgically induced cylinder at two days and one week post-operatively (P < or = .02). The 5.5 mm and 6.5 mm incision cases did not differ significantly in visual acuity or astigmatism at any examination.