A Case of Choroidal and Vitreous Hemorrhage Following Micropulse Transscleral Cyclophotocoagulation.

Choroidal hemorrhages involve bleeding into the potential space between the choroid and sclera and are a serious ocular complication. Common causes of choroidal hemorrhages include intraocular surgeries, such as scleral buckling, cataract extractions, and glaucoma filtering procedures, or trauma. We report a case of choroidal and vitreous hemorrhage after micropulse cyclophotocoagulation. An 82-year-old female presented postoperative day 1 with blurry vision and pain in her right eye. Examination showed that she had a choroidal hemorrhage, 200 degrees of ciliary body swelling, and vitreous hemorrhage. Although the choroidal hemorrhage resolved with steroids, the vitreous hemorrhage required pars plana vitrectomy. To the best of our knowledge, this article discusses the first reported case of choroidal and vitreous hemorrhage due to micropulse cyclophotocoagulation.

Effect of preemptive retrobulbar analgesia on perioperative hemodynamics and postoperative pain after enucleation.

PURPOSE: To determine the preemptive pain and hemodynamic effects of preincisional retrobulbar analgesia in enucleation. METHODS: This double-blinded, placebo-controlled study enrolled 69 patients scheduled for enucleation. Patients were stratified into two groups: those who used daily analgesics before surgery and those who did not. Each group was randomly assigned to receive a preincisional retrobulbar injection containing either a mixture of bupivacaine, lidocaine, epinephrine, and hyaluronidase; or saline placebo. All patients received postoperative retrobulbar injection containing the analgesic mixture. The outcome measures were intraoperative and postoperative blood pressure, heart rate, postoperative pain, and pain medication consumption. RESULTS: Groups that received preincisional analgesia had a significantly lower mean intraoperative blood pressure (109/59 versus 127/69 mm Hg; P< 0.05). Visual analog scale pain assessment (VAS) was lower in both treatment groups upon recovery room entry (VAS, 0.3 versus 15.8, P=0.08) and after 30 minutes in the nonanalgesic use group (VAS, 5.6 versus 19.4, P=0.11). Among nonchronic analgesic users, fewer patients in the treatment group had pain requiring analgesic rescue in the recovery room (5% versus 25%, P=0.08). Postoperative pain medicine consumption in the first 24 hours did not differ significantly among the groups. CONCLUSIONS: Preemptive retrobulbar analgesia was associated with improved intraoperative hemodynamics during enucleation and a trend toward reduced pain on entry in the recovery room and fewer pain rescues in the early postoperative period. A trend toward reduced pain severity in the early postoperative period was observed in those patients without daily preoperative analgesic use.