SCLERAL BUCKLING SURGERY AND EYE PAIN: Assessment of Chronic Eye Pain During the Postoperative Period of Scleral Buckling Surgery

Potential Risk Factors for Ocular Pain in Patients Undergoing Multiple Intravitreal Injections of Anti-Vascular Endothelial Growth Factor

Purpose

To assess ocular pain in patients undergoing multiple intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) who have previous factors that may influence pain sensitivity.

Methodology

This is a prospective, observational, case series study involving patients who underwent multiple (≥3) pro re nata intravitreal injections of ranibizumab or aflibercept to treat any cause of chorioretinal vascular disease. Ocular pain was assessed by the numerical analog scale during intravitreal injection. For this study, the main variable was ocular pain and the secondary variables included age, sex, previous history of glaucoma, primary retinal vascular disease, severe dry eye history, trigeminal pain, scleral buckle surgery, collagen diseases, fibromyalgia, severe migraine history, pars plana vitrectomy, scleral thickness measurements, and type of anti-VEGF.

Results

In a total of 894 patients, 948 eyes (4822 intravitreal injections), 793 patients (88.6%) had ocular pain sensitivity between no pain to mild pain, 80 patients (8.9%) had moderate ocular pain, 15 patients (1.6%) had severe ocular pain, and 6 patients (0.7%) had extremely severe ocular pain. Patients with severe dry eye (p = 0.01) and previous history of scleral buckle surgery (p = 0.01) showed a significant correlation with ocular pain during intravitreal injection. Pars plana scleral thickness (>550 um) and diabetic neuropathy were associated with ocular pain but did not meet the criteria for statistical significance (p = 0.09 and p = 0.06, respectively).

Conclusion

Dry eye and prior scleral buckle surgery may contribute to pain associated with intravitreal injection. These issues should be taken into consideration in patients undergoing multiple intravitreal injections.

Acupoint Selection in Postoperative Ophthalmic Pain Management: A Data Mining Protocol

Background

Postoperative ophthalmic pain not only induces anxiety and depression among patients, but also prolongs the recovery cycle. However, the management of postoperative pain in ophthalmology is still not standardized. The effectiveness of acupuncture in treating postoperative pain has been validated based on numerous clinical trials and meta-analysis. Our study is to conduct the first data mining analysis to identify the most effective acupoints selection and combinations for treating postoperative ophthalmic pain, inform.

Methods

We will search bibliographic databases from inception to November 2023. Clinical trials evaluating the effectiveness of acupuncture therapy in the management of postoperative ophthalmic pain will be selected. Reviews, protocols, animal studies, case reports, systematic evaluations and Meta-analyses will be excluded. Primary outcome indicators will be clinical outcomes related to postoperative ophthalmic pain. Descriptive statistics will be performed in Excel 2019. Association rule analysis will be performed in SPSS Modeler 18.0. Exploratory factor analysis and cluster analysis will be performed in SPSS Statistics 25.0.

Results

This study will investigate the most effective point selection and combination of acupuncture points for the treatment of postoperative ophthalmic pain.

Conclusion

Our findings will provide evidence for the effectiveness and potential therapeutic prescription of acupuncture for postoperative ophthalmologic pain, helping clinicians and patients work together to make more informed decisions.

Efficacy of Perioperative Intravenous Dexamethasone on Postoperative Analgesia in Scleral Buckle Surgery: A Randomized Clinical Trial

BACKGROUND AND OBJECTIVE

Postoperative pain is frequently reported following scleral buckle (SB) surgery. This study assessed the efficacy of perioperative dexamethasone on postoperative pain and opioid use following SB.

MATERIALS AND METHODS

Forty-five patients with rhegmatogenous retinal detachments undergoing SB or SB and pars plana vitrectomy were randomly assigned to either standard care of postoperative oral acetaminophen and oxycodone/acetaminophen as needed or standard care plus 8 mg single-dose peri-operative intravenous dexamethasone. A questionnaire was administered on postoperative days 0, 1, and 7 to determine visual analog scale 0 to 10 pain score and number of opioid tablets consumed.

RESULTS

Mean visual analog scale score and opioid use were significantly lower in the dexamethasone group on postoperative day 0 compared with control (2.76 ± 1.96 vs 5.64 ± 3.40, P = .002; 0.41 ± 0.92 vs 1.34 ± 1.43, P = .016). The dexamethasone group also demonstrated significantly lower total opioid use (0.97 ± 1.88 vs 3.69 ± 5.32, P = .047). No significant differences in pain score or opioid use were observed on days 1 or 7 (P = .078; P = .311; P = .326; P = .334).

CONCLUSION

Single-dose intravenous dexamethasone following SB can significantly reduce postoperative pain and opioid use. [Ophthalmic Surg Lasers Imaging Retina 2023;54(x):X-X.].

Higher Order Aberrations following Scleral Buckling Surgery in Patients with Rhegmatogenous Retinal Detachment

We aim to evaluate magnitudes of higher order aberrations (HOAs) from 3rd–6th order after scleral buckling (SB) for rhegmatogenous retinal detachment (RRD). A retrospective cross-sectional study of 19 patients with RRD who received SB (six receiving encircling SB, thirteen receiving segmental SB) was conducted. A wavefront analysis for surveying HOAs and other ophthalmic parameters were collected. Data between operated and fellow eyes, and a subgroup analysis of operated eyes, were analyzed by the Mann–Whitney U test, while a generalized linear model was applied to evaluate the correlation of HOAs to best-corrected visual acuity (BCVA) and optical symptoms. BCVA in the operated eyes was significantly worse (LogMAR: 0.18 ± 0.23 versus 0.05 ± 0.07, p = 0.001). Tilt (0.32 ± 0.14 versus 0.13 ± 0.08, p = 0.004), defocus (1.78 ± 0.47 versus 1.05 ± 0.17, p = 0.019) and coma (0.43 ± 0.11 versus 0.27 ± 0.09, p = 0.016) were significantly increased after SB. All root mean square (RMS), including RMS-3, RMS-4 and total RMS, were higher in operated eyes (all p < 0.05). Regarding Zernike terms, a significant elevation of vertical coma in the operated eyes was found (p = 0.038). In addition, tilt (0.41 ± 0.10 versus 0.17 ± 0.12, p = 0.007), defocus (2.27 ± 0.58 versus 0.82 ± 0.39, p = 0.001) and coma (0.59 ± 0.17 versus 0.11 ± 0.10, p = 0.015) were higher in the segmental subgroup, whereas spherical aberration (SA) was higher in the encircling subgroup (0.22 ± 0.04 versus 0.40 ± 0.15, p = 0.024) and RMS-4 and total RMS were increased in the segmental subgroup (both p < 0.05). Besides, tilt was correlated to worse BCVA (p = 0.036), whereas all four HOAs were correlated to the presence of optical symptoms (all p < 0.05). In conclusion, SB may increase HOAs, which could be associated with unfavorable postoperative visual outcomes and subject symptoms.

Opioid Prescribing Patterns among Retina Specialists in the United States

PURPOSE

To determine the opioid prescribing patterns among retina specialists and to assess predictors for high-volume prescribing.

DESIGN

Retrospective cohort study.

PARTICIPANTS

American Society of Retina Specialists (ASRS) members in the 2013 through 2016 Medicare Part D Prescriber database.

METHODS

American Society of Retina Specialists members within the United States were profiled from the ASRS member directory as of April 2019. The Centers for Medicare and Medicaid Services Medicare Part D Prescriber Public Use Files for 2013, 2014, 2015, and 2016 were accessed. Data were collected and analyzed regarding the prescribing patterns for opioid drugs for all participating ASRS members.

MAIN OUTCOME MEASURES

Mean number of opioid prescriptions written annually by retina specialists, prescriber rates compared with all prescriptions written, and geographic distribution of opioid prescriptions written by retina specialists.

RESULTS

The authors identified 1518 ASRS members in the Medicare database in 2016. Members had written a total of 14 127 prescriptions in 2016, with 66% of members writing at least 1 opioid prescription. On average, members wrote 11 opioid prescriptions per year. Almost one fifth (21%) wrote more than 10 prescriptions annually. A minority (6%) wrote more than 50 prescriptions. Among those writing more than 10 prescriptions annually, approximately 35 opioid prescriptions were written annually with a mean supply of 4 days. Using multivariate analysis, the factors associated with increased number of opioid prescriptions were male gender (β = 2.80; P < 0.001), a practice location in the South (β = 5.61; P < 0.001), and larger patient panel size (β = 0.029; P < 0.001). The total number of opioid prescriptions, including refills, written by members also decreased by 18% from 2013 to 2016 (P < 0.001).

CONCLUSIONS

American Society of Retina Specialists members prescribed opioids at a rate (1.5%) lower than the national mean of all prescribers across all medical specialties (6.8%). Male gender and a practice location in the South were correlated to number of prescriptions. Further research is needed to elucidate the appropriate indications for the prescription of opioids among retina specialists.

Resolution of pain with periocular injections in a patient with a 7-year history of chronic ocular pain

Purpose

We report a case of a male patient with chronic ocular pain that resolved completely following peripheral nerve blocks.

Observations

A 66-year-old male presented with a seven-year history of severe left eye pain and photophobia. The pain began after retinal detachment repair with scleral buckle placement. Previous treatments included topical (autologous serum tears, corticosteroids, diclofenac, cyclosporine) and oral (gabapentin, diclofenac) therapies with no pain relief. The patient's pain was so severe that he requested enucleation. After discussion, the decision was made to perform periocular nerve blocks. Prior to the procedure, the patient reported an average pain intensity of 8 out of 10 and photophobia daily. Following left supraorbital, supratrochlear, infraorbital and infratrochlear injections with bupivacaine and methylprednisolone, pain intensity and photophobia improved to 1–2 out of 10. One week later, repeat infraorbital and infratrochlear nerve blocks were given, after which time the patient reported complete resolution of symptoms that lasted for 7 months. Repeat nerve blocks were administered with repeat resolution of pain. There were no complications associated with the procedures.

Conclusions and Importance

Chronic ocular pain can be a debilitating condition. Periorbital nerve blocks can provide pain relief and should be considered as a potential treatment option after medical management has failed.

The Combination of Ketorolac with Local Anesthesia for Pain Control in Day Care Retinal Detachment Surgery: A Randomized Controlled Trial

This study aims to evaluate the efficacy of ketorolac with local anesthesia compared to local anesthesia alone for perioperative pain control in day care retinal detachment surgery. The randomized controlled trial included 59 eyes of 59 participants for retinal detachment surgery who were randomly assigned (1 : 1) into the ketorolac (K) group and control (C) group. All participants underwent conventional local anesthesia while patients in the K group received an extra administration of preoperative ketorolac. Participants in the K group had a statistically significantly lower intraoperative NRS score (median 1.0 versus 3.0, P = 0.003), lower postoperative NRS score (median 0 versus 1.0, P = 0.035), fewer proportion of rescue analgesic requirement (10% versus 34.5%, P = 0.023), and lower incidence of postoperative nausea and vomiting (13.3% versus 41.4%, P = 0.015) compared to the C group. Intraocular pressure (IOP) changes (△IOP) were significantly reduced in the K group (median 1.9 versus 3.0, P = 0.038) compared to the C group 24 hours postoperatively. In conclusion, the combination of local anesthesia with ketorolac provides better pain control in retinal detachment surgery compared to local anesthesia alone. The beneficial effect of ketorolac with local anesthesia may contribute to a wider-spread adoption of day care retinal detachment surgery. This trial is registered with ClinicalTrials.gov NCT02729285.