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OBJECTIVE: Smoking is an important risk factor for Graves orbitopathy (GO) and it is modifiable. The advice to stop smoking has been included in all the clinical practice guidelines of GO. However, the effectiveness of this practice remains unknown. The purpose of this study is to assess the change in the smoking habit in patients affected with GO after an oral counselling for smoking cessation. MATERIAL AND METHODS: A retrospective cohort of GO patients was studied. The patients received a significant oral counsel during the first consultation with the ophthalmologist. 33 GO patients were explored in the ophthalmology clinic during 2013 and 2014 and the study was done throughout a telephone questionnaire in 2015. The main outcome was the number of cigarettes smoked daily before and after consultation with the endocrinologist and the ophthalmologist. Other medical and socioeconomic factors were recorded. RESULTS: The mean number of cigarettes that were smoked was 13.6 (SD 9.66) and 6.3 (SD 7.73) before and after the consultation done at the ophthalmology office (T-test paired, P=0.0006). 42.42% achieved smoking cessation and 30.3% decreased their smoking habit. Patients who stopped smoking suffered usually from active and severe GO, had more stable jobs and received greater support from their relatives and friends. CONCLUSION: A firm and strong oral counsel held for smoke cessation was effective in GO patients. This disease deeply affects patients' quality of life, making them more prone to change their habits.

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PURPOSE: To review the therapeutic options in the management of residual esotropia, particularly focusing on the effectiveness of botulinum toxin. METHODS: Retrospective study of cases of post-surgical residual esotropia treated in our hospital from January 1999 to January 2008. Visual acuity and motor outcomes were analysed in the patients who received botulinum toxin injection. RESULTS: Of the 200 cases reviewed, 91% of the patients had a new surgery, 5% of patients refused any treatment, while 8 patients (4%) received botulinum toxin injection. Visual acuity (Snellen) before surgery, before toxin and after toxin injection in the right eye was 0.77 (SD 0.2), 0.86 (SD 0.2) and 0.97 (SD 0.2), respectively, and in the left eye: 0.76 (SD 0.1), 0.91 (SD 0.09) and 0.97 (SD 0.2), respectively. The percentage net change in the angle of deviation at far and near distance after toxin injection in the last follow-up was 41.66% and 10%, respectively. The mean follow-up after botulinum toxin injenction was 30.8 months. The success rate (ocular alignment in primary eye position) after toxin at the end of follow-up was 75%. CONCLUSIONS: Residual esotropia may be managed with further surgery or with botulinum toxin injection. The first option is more common, but in selected cases botulinum toxin injection may provide very successful outcomes with a low incidence of complications.

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PURPOSE: To study the relationship between retinal nerve fiber layer (RNFL) thickness measurements from time domain (Stratus) and spectral domain (Cirrus HD) optical coherence tomography (OCT) in subjects with optic neuritis. METHODS: A total of 18 patients who had suffered monocular acute optic neuritis were imaged by a single trained operator using the Stratus-OCT (fast RNFL scan mode) and Cirrus HD-OCT (optic disc cube mode) on the same day. The relationship between RNFL thickness measurements of the two OCTs (overall and by quadrants) were evaluated using intraclass correlation coefficient (ICC) and Bland-Altman plots. Comparisons between eyes having optic neuritis (ON-group) and fellow eyes (fellow-group) were assessed by a generalized estimating equation (GEE) regression model. RESULTS: For Stratus-OCT, the median average RNFL was 86.3 and 102 µ in the ON-group and in the fellow-group, respectively. For Cirrus-OCT, the corresponding measurements were 81 and 93 µ. Average RNFL thickness as determined by the two OCT devices was well correlated in the ON-group (ρ = 0.906, P< 0.001) and in the fellow-group (ρ = 0.702, P = 0.001). The median signal strength was significantly higher with Cirrus-OCT. Bland-Altman plots showed that Stratus RNFL measurements were larger than Cirrus-OCT, but smaller when average RNFL thickness was very thin (≤ 56 µ). CONCLUSIONS: Although the Cirrus-OCT and Stratus-OCT RNFL thickness measurements are well correlated in patients with optic neuritis, RNFL measurements cannot be directly compared. Clinicians should be aware that measurements are generally higher with Stratus- than with Cirrus-OCT.

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The medical treatment of glaucoma has undergone significant development in recent years. Research in this field is focused on improving pre-existing drugs and on the development of new molecules. In relation to commercial drugs, there is a trend to improve local tolerance, using less toxic preservatives as in the case of sofZIA in travoprost, and eliminating the preservatives as in tafluprost. The development of new, fixed combinations of commercial drugs could also enhance their administration and therapeutic compliance. There is also intense research activity in the search for new therapeutic groups for glaucoma treatment. Calcium channel-blockers such as lomerizine do not seem to affect systemic hypotension, while topical calcium-blockers like flunarizine and iganidipine are also under research. Endothelin 1 antagonists such as sulfisoxazole and bunazosine could be also useful in the treatment of glaucoma. In the renin angiotensin system, angiotensin (1-7) and olmesartan are under investigation for use in glaucoma patients. Trabecular drugs such as Rho-kinase inhibitors could be effective on the pathogenic mechanism of primary open angle glaucoma. Finally, topical mifepristone, an antagonist of glucocorticoid receptors, is under evaluation for corticosteroid-induced elevated intraocular pressure (Arch Soc Esp Oftalmol 2009; 84: 491-500).

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