ABSTRACT
Purpose@#We report an atypical case of ischemic oculomotor palsy occurring sequentially in both eyes and then improving, followed by a new abducens palsy in a diabetic patient with poor blood sugar control.Case summary: A 51-year-old woman presented with diplopia, dizziness, and pain in the right eye and was diagnosed with oculomotor palsy in the right eye. Magnetic resonance imaging of her brain was normal but glycated hemoglobin concentration was 13.4%. After 2 months, the third nerve palsy in the right eye had recovered completely but a new third nerve palsy occurred in the left eye. 1 month later, the symptoms had improved, and the patient did not return to our clinic until 18 months later, when she returned with new diplopia. This time, she was diagnosed with a sixth nerve palsy in the left eye and was observed while controlling her blood sugar. She recovered after 4 months. @*Conclusions@#Generally, cranial nerve palsies occur unilaterally in situations that can cause ischemia, such as diabetes, high blood pressure, and hyperlipidemia. Rarely, they occur bilaterally, or two or more cranial nerve palsies occur simultaneously. However, it is very rare that cranial nerve palsy occurs sequentially in both eyes under the same systemic blood sugar control. Diabetic patients with poor blood sugar control require long-term monitoring, considering the possibility of symptoms developing in both eyes with a time lag or other forms of ischemic cranial nerve palsy.
ABSTRACT
Purpose@#We sought correlations between the subfoveal choroidal thickness (SCT) and changes in the levels of aqueous humor cytokines before and after anti‐vascular endothelial growth factor (anti‐VEGF) treatment of patients with neovascular age‐related macular degeneration (nAMD) and pachychoroid neovasculopathy. @*Methods@#We measured changes in the SCT and levels of aqueous humor cytokines (VEGF, soluble VEGF receptor‐2 [sVEGFR‐ 2], platelet‐derived growth factor [PDGF]‐AA, monocyte chemoattractant protein 1 [MCP‐1], interleukin [IL]‐6, and IL‐8) after anti‐ VEGF treatment of 11 eyes of 11 nAMD patients and nine eyes of nine pachychoroid neovasculopathy patients. The aqueous humor cytokine levels were compared between the two groups. @*Results@#After anti‐VEGF treatment, the aqueous levels of VEGF and PDGF‐AA decreased significantly, whereas that of sVEGFR‐2 increased. The amount of change in sVEGFR‐2 concentration before and after anti‐VEGF treatment correlated with the SCT and its change after treatment. nAMD patients with relatively thin SCTs and smaller SCT changes after anti‐VEGF treatment showed greater increases in sVEGFR‐2 levels following treatment. We found significant correlations among the MCP‐1, IL‐6, and IL‐8 levels in the nAMD group, and between the sVEGFR‐2 and MCP‐1, and MCP‐1 and PDGF‐AA, levels in the pachychoroid neovasculopathy group. @*Conclusions@#Patients with nAMD exhibited significant increases in aqueous sVEGFR‐2 levels following anti‐VEGF treatment and significant correlations among the levels of the inflammatory cytokines MCP‐1, IL‐6, and IL‐8, suggesting that angiogenic factors and inflammatory cytokines may affect the pathophysiologies of the two diseases differently.
ABSTRACT
Purpose@#To report a case of accidental swallowing of nasal packing gauze during silicone tube intubation under local anesthesia.Case summary: A 58-year-old male patient underwent silicone tube intubation for partial nasolacrimal duct obstruction on the right side. In preparing for surgery, six cottonoids soaked were packed in righ nasal cavity, to facilitate anesthesia and prevent bleeding. Strings detectable by X-ray were attached at the cottonoids and cut 5 cm from the nostrils. After surgical hand scrubbing, the strings were not present. One cottonoid was found in the nasal cavity, but five cottonoids could not be detected by endonasal endoscopic exploration. The patient said he swallowed “something like sputum”. He did not notice any discomfort and the surgery was performed as scheduled. Abdominal X-ray performed immediately after surgery showed the presence of the five strings in the stomach. The strings were not seen on X-ray conducted 4 days later. The patient defecated normal stools three times and did not notice any discomfort over the course of 4 days. @*Conclusions@#Surgeons need to be aware of the possibility of accidental swallowing of nasal packing gauze during nasolacrimal duct surgery. Use of gauze detectable by X-ray is helpful to determine its location.