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4 results

  • Chapter 21 - Botulinum Toxin in Ophthalmology

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 180-187

  • Summary

    In ophthalmology, botulinum toxin injections are the treatment of choice in essential blepharospasm and hemifacial spasm. However, there are many other indications for botulinum toxin around the eye and orbit, such as several forms of strabismus, especially sixth nerve palsy and vertical strabismus in Graves’ disease, convergence spasm, injection in the lacrimal gland for crocodile tears and lacrimal outflow obstruction, eyelid retraction in thyroid eye disease, protective ptosis in lagophtalmos and corneal wounds and entropion. The injection technique is explained in detail including electromyography (EMG) recordings from the eye muscles and injections in the lacrimal gland and the upper eyelid.

  • Use of pre-operative calcium and vitamin D supplementation to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy: a systematic review

  • A S Khatiwada, A S Harris
  • Journal:
    The Journal of Laryngology & Otology / Volume 135 / Issue 7 / July 2021
    Published online by Cambridge University Press:
    14 June 2021, pp. 568-573
    Print publication:
    July 2021
  • Objective

    This systematic review aimed to establish the evidence behind the use of pre-operative calcium, vitamin D or both calcium and vitamin D to prevent post-operative hypocalcaemia in patients undergoing thyroidectomy.

    Method

    This review included prospective clinical trials on adult human patients that were published in English and which studied the effects of pre-operative supplementation with calcium, vitamin D or both calcium and vitamin D on the rate of post-operative hypocalcaemia following total thyroidectomy.

    Results

    Seven out of the nine trials included reported statistically significantly reduced rates of post-operative laboratory hypocalcaemia (absolute risk reduction, 13–59 per cent) and symptomatic hypocalcaemia (absolute reduction, 11–40 per cent) following pre-operative supplementation.

    Conclusion

    Pre-operative treatment with calcium, vitamin D or both calcium and vitamin D reduces the risk of post-operative hypocalcaemia and should be considered in patients undergoing total thyroidectomy.

  • Pre-operative serum alkaline phosphatase as a predictive indicator of post-operative hypocalcaemia in patients undergoing total thyroidectomy

  • M S Miah, S Mahendran, C Mak, G Leese, D Smith
  • Journal:
    The Journal of Laryngology & Otology / Volume 129 / Issue 11 / November 2015
    Published online by Cambridge University Press:
    29 September 2015, pp. 1128-1132
    Print publication:
    November 2015
  • Objective:

    This study aimed to evaluate whether a pre-operative elevated serum alkaline phosphatase level is a potential predictor of post-operative hypocalcaemia after total thyroidectomy.

    Methods:

    Data was retrospectively collected from the case notes of patients who had undergone total thyroidectomy. Patients were divided into Graves’ disease and non-Graves’ groups. Pre-operative and post-operative biochemical markers, including serum calcium, alkaline phosphatase and parathyroid hormone levels, were reviewed.

    Results:

    A total of 225 patients met the inclusion criteria. Graves’ disease was the most common indication (n = 134; 59.5 per cent) for thyroidectomy. Post-operative hypocalcaemia developed in 48 patients (21.3 per cent) and raised pre-operative serum alkaline phosphatase was noted in 94 patients (41.8 per cent). Raised pre-operative serum alkaline phosphatase was significantly associated with post-operative hypocalcaemia, particularly in Graves’ disease patients (p< 0.05).

    Conclusion:

    Pre-operative serum alkaline phosphatase measurements help to predict post-thyroidectomy hypocalcaemia, especially in patients who do not develop hypoparathyroidism. Ascertaining the pre-operative serum alkaline phosphatase level in patients undergoing total thyroidectomy may help surgeons to identify at-risk patients.