RESUMO
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.
RESUMO
Purpose: To compare the outcomes of standard pop-titrated transscleral cyclophotocoagulation (TSCPC) and slow-coagulation TSCPC in the treatment of glaucoma. Design: Retrospective case series. Subjects: This study included 78 eyes with glaucoma of any type or stage that underwent TSCPC as part of their treatment course. Methods: This study compared 52 eyes treated with slow coagulation TSCPC to 26 eyes treated with standard pop-titrated TSCPC. Patient demographics, treatment course, surgical techniques, settings and outcomes were assessed. Main Outcome Measures: The main outcome measures were visual acuity (VA), intraocular pressure (IOP) and post-surgical complications. Results: The initial LogMAR VA was 1.94 (0.73) [mean (SD)] in the slow coagulation TSCPC group and 1.71 (0.90) in the standard TSCPC group (p=0.507). Initial IOP was 37 (13) mm Hg in the slow coagulation group and 39 (13) mm Hg in the standard group (p=0.297). The follow-up periods were 16.36 months and 24.68 months for the slow coagulation and standard groups (p=0.124). VA remained better than light-perception in 71.1% of slow coagulation treated patients and 65.0% of standard TSCPC treated patients (p=0.599). IOP remained below 20 mm Hg in 46% of slow coagulation treated patients and 44% of standard TSCPC treated patients (p=0.870). The mean number of complications was higher in the standard group [1.46 (1.24)] versus the slow coagulation group [0.62 (0.75)] (p=0.002). The incidence of the need for a second procedure (slow coagulation- 28.8%, standard- 23.1%, p=0.588) and maximum number of medications needed to control IOP postoperatively (p=0.771) were similar between the two groups. Conclusions: In this case series, slow coagulation TSCPC and standard pop-titrated TSCPC resulted in similar VA and IOP outcomes in the treatment of glaucomatous eyes. The complication profiles of the techniques were also comparable, although standard TSCPC had a higher incidence of prolonged inflammation postoperatively. This study suggests that slow coagulation TSCPC may achieve equivalent control of IOP while reducing the incidence of prolonged post-operative inflammation-a feared complication of TSCPC-when compared to standard "pop-titrated" TSCPC.