BACKGROUND

Corticosteroids have been used in ophthalmology for its potent anti-inflammatory and immunosuppressive actions. Although the role of corticosteroid treatment is pivotal in the treatment of numerous inflammatory diseases and as postoperative management of patients who undergo ocular surgeries, intraocular pressure (IOP) elevation has been a significant ocular side effect that could result after steroid use. Evaluating the changes in IOP in pediatric eyes will provide early detection and timely intervention to prevent glaucomatous optic neuropathy.

OBJECTIVE

This study aimed to determine the incidence of IOP elevation among pediatric patients given corticosteroids after strabismus surgery in a tertiary hospital in Manila, Philippines.

METHODS

This is a single-center, retrospective, observational study that employs review of the clinical records of pediatric patients who underwent strabismus surgery between January 2015 and December 2022. This study was conducted last February to November 2023. Data were gathered and descriptively summarized regarding patient demographics, ophthalmologic diagnosis, type of strabismus surgery performed, preoperative and postoperative IOP readings, frequency and duration of postoperative topical steroid use, and treatment received and response to elevated IOP.

RESULTS

Forty-five (28.48%) out of the 158 pediatric patients who had strabismus surgery during the study period met the inclusion criteria for the study. The mean age of pediatric patients was 11.38 ± 5.28 years (range 2-18 years old). There were more males (55.6%) than females. All patients were administered Tobramycin + Dexamethasone eyedrops, ointment or both. The baseline, peak, and net change in IOP were 13.5 ± 2.7 mmHg, 23.1 ± 8.8 mmHg and 10 ± 8.4 mmHg respectively. IOP increased in thirty-seven (82.2%) of the patients from baseline, and 21 (56.7%) of them had a considerable rise. For most patients with considerable rise of IOP, topical steroid medication was either stopped or immediately tapered off. Nine patients received topical IOP-lowering medicine, and most of them returned to normal IOP levels two months following surgery. After then, topical IOP-lowering drugs were stopped.

CONCLUSION

IOP elevation following strabismus surgery was frequently associated with topical steroid usage, and most patients experienced considerable IOP elevation. It is highly advised to closely monitor IOP following strabismus surgery, particularly in children receiving topical steroid treatment.

Human ; Male ; Female ; Child Preschool: 2-5 Yrs Old ; Child: 6-12 Yrs Old ; Adolescent: 13-18 Yrs Old ; Strabismus ; Intraocular Pressure ; Ophthalmology ; World Health Organization ; Optic Nerve Diseases ; Volition ; General Surgery

OBJECTIVE

To discuss the clinical presentation and management of idiopathic hypertrophic pachymeningitis that presented with multiple cranial neuropathies.

METHODS

This is a case report.

CASE PRESENTATION

A 37-year-old female presented with right-sided headache and ipsilateral cranial nerve (CN) I, II, III, IV, and V deficits which improved with nonsteroidal anti-inflammatory drugs (NSAIDs). Six months later she developed bilateral blurring of vision with pain on eye movement, which progressed to severe bilateral affectation that prompted admission and treatment with high-dose methylprednisolone therapy followed by prolonged oral steroid treatment which was gradually tapered. Recurrence was treated with oral steroids and azathioprine. Diagnostic modalities included an initial cranial contrast computed tomography (CT) scan which was inconclusive; contrast magnetic resonance imaging (MRI) clinched the diagnosis, as well as demonstrated thickening of the optic nerve perineurium. Visual field analysis 30-2 as well as optic nerve head optical coherence tomography (OCT) were used to support the diagnosis and document optic nerve affectation. Biologic testing was used to rule out tuberculosis, syphilis, fungal infection, granulomatosis with polyangiitis, polyarteritis nodosa, and rheumatoid arthritis. The patient had complete vision recovery in the left eye but only partial vision recovery in the right eye.

CONCLUSIONS

Pachymeningitis should be a diagnostic consideration in patients with headache and multiple cranial neuropathies. Clinicians should always perform independent evaluation of diagnostic modalities with the patient’s clinical presentation in mind. Pachymeningitis can involve the perineurium through contiguous spread of the lesion and present as optic perineuritis as well, with more insidious progression and lasting deficits than isolated optic perineuritis.

Human ; Female ; Adult: 25-44 Yrs Old ; Cranial Nerve Diseases ; Meningitis

Introduction: Cranial nerve palsies have been reported in patients with uncontrolled hypothyroidism. We describe a case of overt hypothyroidism due to treatment disruption following radioiodine therapy, presented with a unilateral lower motor neuron seventh cranial nerve palsy. Case: A 32-year-old female presented with hypertension, dyslipidemia, class III obesity, and Graves’ disease post radioiodine therapy. She had stable thyroid function test with levothyroxine replacement post radioiodine. She presented with a 3-day history of right-sided facial droop associated with lethargy, weight gain, and constipation. She reported inadequate levothyroxine supply due to 2-month lapses in follow-up. On examination, there was a right-sided lower motor neuron 7th cranial nerve palsy with delayed ankle reflexes. No additional neurological deficits, goiter, cutaneous rashes, or vesicular lesions were noted. There was no preceding viral illness or otologic symptoms. Thyroid function tests showed overt hypothyroidism with thyroid-stimulating hormone 38 mIU/L, free thyroxine <5.4 pmol/L with a deranged lipid profile (total cholesterol: 8.8 mmol/L, low-density lipoprotein: 5.72 mmol/L, triglyceride: 1.77 mmol/L). Renal and liver function tests were within normal limits, with no leukocytosis. Neuroimaging of the brain was unremarkable. She was commenced on a short course of high-dose prednisolone, with no improvement in symptoms. Levothyroxine replacement therapy initiated led to progressive restoration of thyroid function, accompanied by symptom recovery. Conclusion Isolated lower motor 7th nerve palsy has been reported as a manifestation of hypothyroidism. This case underscores the importance of early recognition to enable timely and appropriate management, as patients with hypothyroidisminduced isolated seventh nerve palsy demonstrate marked recovery with adequate levothyroxine replacement.
Facial Nerve ; Hypothyroidism ; Motor Neurons ; Paralysis

BACKGROUND

Traumatic peripheral nerve injury (TPNI) is a debilitating condition that may result in significant disability. There is variability in the epidemiology, clinical profile, and mechanism of injury worldwide, but data for low- and middle-income countries (LMICs) such as the Philippines are sparse.

OBJECTIVE

We aimed to determine the demographic and clinical characteristics, management, and outcomes of patients who sustained TPNI in our center.

METHODS

We performed a retrospective cohort study of all patients referred for TPNI at our institution from 2013 to 2019. Data on demographics, clinical features, etiology, surgical management, and status on last follow-up were collected.

RESULTS

Forty-four patients with injuries to 62 peripheral nerves were included in the cohort, which had a strong male predilection (98%). The mean age at diagnosis was 35.5 years, with 78% of patients aged between 16-45 years. The most common etiologies were laceration due to sharp objects (39%), stab wound (23%), hacking injury (14%), and vehicular crash (14%). In terms of mechanism of nerve injury, the most common was sharp laceration (80%), followed by stretch injury/nerve injury in continuity (14%). The most commonly injured nerves were the ulnar (36%) and median nerves (32%), more often on the right side (66%). Nerve repair surgery was performed in 80% of cases.

CONCLUSION

TPNIs in a tertiary center in the Philippines most commonly involved young males in the working age group and were caused by occupational and domestic accidents. Appropriate surgical management of TPNI is feasible in low resource settings.

Human ; Peripheral Nerve Injuries ; Trauma ; Wounds And Injuries ; Philippines

OBJECTIVE: To evaluate the clinical efficacy of ultrasound-guided needle knife release with different pathways for carpal tunnel syndrome (CTS). METHODS: Sixty CTS patients were randomly divided into a transverse group and a longitudinal group, with 30 patients in each group. The transverse group received the needle knife release under ultrasound above and below the median nerve along the short axis, while the longitudinal group received the needle knife release under ultrasound above the median nerve along the long axis. The patients' visual analogue scale (VAS) scores, Levine scores, and median nerve cross-section area (CSA) were assessed before treatment, on the 7th, 14th, and 30th days after treatment. The median nerve conduction indexes (motor conduction: latency [Lat], amplitude[Amp], motor conduction velocity [MCV]; sensory conduction: Lat, Amp, sensory conduction velocity [SCV]) were evaluated before treatment and on the 30th day after treatment. RESULTS: Compared before treatment, the VAS scores, Levine scores, and median nerve CSA were reduced in both groups on the 7th, 14th, and 30th days after treatment (P<0.05); the transverse group showed lower VAS and Levine scores and smaller CSA than those in the longitudinal group (P<0.05). On the 30th day after treatment, motor and sensory Lat was reduced (P<0.05), motor and sensory Amp was increased (P<0.05), and MCV and SCV were faster (P<0.05) in both groups. The transverse group had shorter Lat, higher Amp, and faster MCV and SCV than those in the longitudinal group (P<0.05). CONCLUSION The ultrasound-guided needle knife release with transverse and longitudinal pathways could both effectively alleviate pain and improve median nerve conduction in CTS patients, with the transverse pathway showing superior efficacy to longitudinal pathway.
Humans ; Carpal Tunnel Syndrome/therapy* ; Female ; Middle Aged ; Male ; Adult ; Median Nerve/physiopathology* ; Acupuncture Therapy/instrumentation* ; Treatment Outcome ; Neural Conduction ; Aged ; Ultrasonography

OBJECTIVE: To observe the effect of transcutaneous electrical acupoint stimulation (TEAS) on postoperative pain in patients undergoing modified radical mastectomy for breast cancer. METHODS: A total of 140 female patients scheduled for unilateral modified radical mastectomy for breast cancer undergoing general anesthesia were randomized into a TEAS group (70 cases) and a sham TEAS group (70 cases, 2 cases dropped out). Patients in both groups received TEAS or sham TEAS at bilateral Neiguan (PC6), Zusanli (ST36), and Danzhong (CV17), respectively, from 30 min before anesthesia induction until the end of surgery, and on 1st, 2nd, and 3rd days after surgery for 30 min a time, once a day. On 1st, 2nd, and 3rd days after surgery, the pain visual analogue scale (VAS) score was observed; on 3, 6, 12 months after surgery, the incidence rate of chronic pain was observed; before surgery, and on 1st, 3rd, and 7th days after surgery, the serum levels of tumor necrosis factor (TNF)-α, interleukin (IL)-6 and IL-10 were detected; the number of analgesia pump press, rescue analgesia, and the occurrence of adverse reaction after surgery were recorded in the two groups. RESULTS: In the TEAS group, the VAS scores on 1st and 2nd days after surgery, and the incidence rates of chronic pain on 3 and 6 months after surgery were lower than those in the sham TEAS group (P<0.05). On 1st, 3rd, and 7th days after surgery, the serum levels of TNF-α, IL-6, and IL-10 were increased compared with those before surgery in both groups (P<0.05, P<0.01); the above indexes in the TEAS group were lower than those in the sham TEAS group (P<0.05). The number of analgesia pump press and the incidence rate of rescue analgesia after surgery in the TEAS group were lower than those in the sham TEAS group (P<0.05). There was no statistically significant difference in the incidence of adverse reactions after surgery between the two groups (P>0.05). CONCLUSION TEAS can effectively improve both the postoperative acute pain and chronic pain in patients undergoing modified radical mastectomy for breast cancer, the mechanism may relate to inhibiting the inflammatory reaction.
Humans ; Female ; Acupuncture Points ; Pain, Postoperative/blood* ; Middle Aged ; Breast Neoplasms/surgery* ; Adult ; Transcutaneous Electric Nerve Stimulation ; Mastectomy, Modified Radical/adverse effects* ; Interleukin-6/blood* ; Tumor Necrosis Factor-alpha/blood* ; Interleukin-10/blood* ; Aged

OBJECTIVE: To observe the efficacy and safety of eye transcutaneous electrical acupoint stimulation (Eye-TEAS) on preventing the progression of pre-myopic to myopia in children aged 6-12 years. METHODS: A total of 170 pre-myopic children aged 6-12 years were randomly divided into an Eye-TEAS group (85 cases, 3 cases dropped out, 2 cases were eliminated) and a placebo Eye-TEAS group (85 cases, 3 cases dropped out, 2 cases were eliminated). The Eye-TEAS group received Eye-TEAS intervention at bilateral Cuanzhu (BL2), Yuyao (EX-HN4), Sizhukong (TE23), Taiyang (EX-HN5), Sibai (ST2), and Jingming (BL1), with continuous wave at a frequency of 4 Hz and a current of 1-2 mA for 30 min per session. The placebo Eye-TEAS group received sham intervention with the same equipment and procedure, but no electrical stimulation. Both groups received intervention once every other day, at least 3 times a week, for a duration of 20 weeks. After intervention and during the 28-week follow-up period after the intervention completion, the changes in axial length (AL), spherical equivalent refraction (SER), and the incidence of myopia were compared between the two groups. Adherence and safety during the intervention period were also evaluated. RESULTS: Compared before intervention, both groups showed an increase in AL after the intervention and during the follow-up (P<0.01). The AL during follow-up was higher than that after the intervention in the two groups (P<0.01). The Eye-TEAS group exhibited a smaller change in AL than the placebo Eye-TEAS group after the intervention and during follow-up (P<0.01, P<0.05). Compared before intervention, both groups showed a decrease in SER after the intervention and during follow-up (P<0.01). The SER during follow-up was lower than that after the intervention in the two groups (P<0.01). The Eye-TEAS group had a higher SER than the placebo Eye-TEAS group after the intervention (P<0.05). The Eye-TEAS group exhibited a smaller change in SER than the placebo Eye-TEAS group after the intervention and during follow-up (P<0.01). The incidence of myopia in the Eye-TEAS group was lower than that in the placebo group during follow-up (20.0% [14/70] vs 34.7% [25/72], P<0.05). Both groups had good adherence, with no adverse events related to the intervention. CONCLUSION Eye-TEAS can delay the progression of pre-myopic to myopia in children, and has a high safety profile.
Humans ; Child ; Male ; Female ; Acupuncture Points ; Myopia/prevention & control* ; Transcutaneous Electric Nerve Stimulation ; Treatment Outcome ; Disease Progression

This paper analyzed the causes of peripheral nerve injury induced by acupoint injection, and proposed methods for prevention. These methods included emphasizing the physicochemical properties of medications and strengthening research on medication compatibility, classifying high-risk acupoints and establishing international standards for safe acupoint needling, standardizing clinical procedures for acupoint injection, and incorporating ultrasound technology when necessary to improve the accuracy and safety of the procedure. These strategies aimed to reduce the risk associated with the clinical application of acupoint injection.
Humans ; Peripheral Nerve Injuries/prevention & control* ; Ultrasonography ; Acupuncture Points ; Injections/adverse effects*

The paper reports acupuncture treatment for one case of oculomotor nerve palsy after cranial-orbital communicating tumor surgery. The acupoint prescription was composed of the local acupoints of the eyes (Yansanzhen, Tijian, Cuanzhu [BL2], Yuyao [EX-HN4] and Sizhukong [TE23]), the acupoints on the head, face and neck (Yangbai [GB14], Sibai [ST2] and Fengchi [GB20]), Guanyuan (CV4) on the abdomen, and those on the four limbs (Hegu [LI4], Zusanli [ST36], Shenmai [BL62] and Zhaohai [KI6]). The point-to-point needling technique with the eyelid lifted was operated at Tijian, Cuanzhu (BL2), Yuyao (EX-HN4), and Sizhukong (TE23). Warm needling with moxa cone placed on the needle handle was operated at Guanyuan (CV4) and Zusanli (ST36), and the usual needling technique was delivered at the rest acupoints. The treatment was given once daily, discontinued for 1 day after every 6 treatments. One course of treatment was composed of 7 days, and 6 courses were required. After treatment completion, the upper eyelids were basically symmetrical and the bilateral eye cracks were equal, the double vision appeared occasionally. No recurrence and no aggravation were reported in 1 month of follow up visit.
Humans ; Acupuncture Points ; Acupuncture Therapy ; Oculomotor Nerve Diseases/etiology* ; Orbital Neoplasms/surgery* ; Postoperative Complications/etiology*

This article reports a case of multiple cranial nerve injury after gamma knife radiosurgery treated with acupuncture and moxibustion combined with rehabilitation therapy. The patient presented with weakness of facial and tongue muscles, hoarseness, choking on water, and swallowing difficulties. The syndrome was attributed to qi and blood deficiency, and blood stasis obstructing the collaterals. The treatment principle focused on replenishing qi and blood, promoting blood circulation and unblocking collaterals. Yintang (GV24⁺), Lianquan (CV23), Qihai (CV6), Guanyuan (CV4), and Cuanzhu (BL2), Yangbai (GB14), Jingming (BL1), Sizhukong (TE23), Yingxiang (LI20), Sibai (ST2), Juliao (ST3), Quanliao (SI18), Dicang (ST4), Jiache (ST6), Xiaguan (ST7), Taiyang (EX-HN5) on the affected side, bilateral Jinjin (EX-HN12), Yuye (EX-HN13), Hegu (LI4), Zusanli (ST36), Sanyinjiao (SP6), Tianshu (ST25) were selected. Among these, bilateral Jinjin (EX-HN12) and Yuye (EX-HN13) were treated with pricking, Dicang (ST4) and Jiache (ST6) on the affected side were connected to an electroacupuncture device, and warming acupuncture was applied at Guanyuan (CV4). Rehabilitation therapy and electromyographic biofeedback were also incorporated. The treatments were given 2-3 times a week. After 18 months of intermittent treatment, the patient reported significant improvement, House Brackmann (H-B) facial nerve function grade was Ⅳ, and Sunnybrook facial nerve rating scale score was 53 points. After 2-month of follow-up, the patient reported normal swallowing ability and restored social engagement.
Humans ; Acupuncture Points ; Acupuncture Therapy ; Cranial Nerve Diseases/therapy*