Trigeminal neuralgia associated with ophthalmic surgery: a case series.

BACKGROUND: Trigeminal neuralgia is a rare cause of postoperative pain after ophthalmic surgery and has only been described twice in the international literature: one case of pain after vitrectomy with a crystalline lens extraction and another case of an unspecified surgery type. We report three cases of ophthalmic surgery-induced trigeminal neuralgia. CASE PRESENTATION: Trigeminal neuralgia was diagnosed in three patients after ophthalmic surgery. Patient 1 was a 63-year-old Caucasian man with an epiretinal membrane and cataract in his left eye. Phacovitrectomy was performed. Patient 2 was a 38-year-old Caucasian man with a perforating wound in his right eye. Primary closure of the cornea with removal of the necrotic iris was performed. Patient 3 was a 52-year-old Caucasian man referred 15 days after suffering blunt trauma to his right eye. Vitrectomy was performed to remove the crystalline lens, which was luxated to the vitreous. On postoperative days, these three patients were admitted to an emergency ward due to sudden, shock-like, one-sided facial pain activated by numerous stimuli. After consultation with specialists from the anesthesia and neurology departments, a diagnosis of trigeminal neuralgia was made. This diagnosis was based on the presence of four of the nine clinical criteria described by the International Headache Society, which were met in these three cases. CONCLUSIONS: Trigeminal neuralgia is a rare cause of postoperative ophthalmic pain and is a challenging diagnosis for the ophthalmologist. It is necessary to consider the differential diagnosis of atypical pain after ophthalmic surgery.

Multifocal electrophysiologic findings after intravitreal bevacizumab (avastin) treatment.

PURPOSE: To determine the short-term safety of intravitreal bevacizumab by multifocal electroretinography testing. METHODS: Thirty-one eyes with choroidal neovascularization, proliferative diabetic retinopathy, and retinal vein occlusion received intravitreal bevacizumab (2.5 mg/0.1 mL). All patients underwent best-corrected visual acuity measurement, retinal fluorescein angiography, optical coherence tomography, and multifocal electroretinography at baseline and 1 month after the treatment. RESULTS: Subjects undergoing multifocal electroretinography testing had no statistically significant changes in electrophysiologic responses 1 month after the intravitreal injection of bevacizumab. CONCLUSION: Multifocal electrophysiologic testing did not demonstrate any short-term cone photoreceptor toxicity after intravitreal bevacizumab.

Tractional retinal detachment after intravitreal injection of bevacizumab in proliferative diabetic retinopathy.

PURPOSE: To assess the short-term complications of a single dose of intravitreal bevacizumab in patients with proliferative diabetic retinopathy (PDR). METHODS: Retrospective review of 343 patients with PDR who were treated with intravitreal injection of bevacizumab (2.5 mg/0.1 mL). RESULTS: Five patients (1.45%) presented tractional retinal detachment 1 to 6 weeks (mean 3 weeks) after intravitreal injection. All cases underwent pars plana vitrectomy, removal of all epiretinal fibrovascular membranes, further endolaser panretinal photocoagulation, and silicone tamponade. CONCLUSION: Tractional retinal detachment may occur in a short time post intravitreal injection of bevacizumab in patients with proliferative diabetic retinopathy with extensive areas of ischemia and fibrovascular proliferations, and may require prompt vitreoretinal surgery.

A pilot study of intravitreal bevacizumab for the treatment of central serous chorioretinopathy (case reports).

BACKGROUND: We report the use of intravitreal bevacizumab as a new option in the treatment of central serous chorioretinopathy (CSC). METHODS: Five eyes with retinal pigment epithelium (RPE) leaks secondary to CSC received intravitreal bevacizumab (2.5 mg/0.1 cc), and underwent best corrected visual acuity, fluorescein angiography and optical coherent tomography before, 1, 3 and 6 months after treatment. RESULTS: All patients showed improvement in visual acuity, fluorescein angiographic leakage, and reduced or resolved neurosensory detachment following treatment. CONCLUSIONS: Intravitreal injection of bevacizumab was associated with visual improvement and reduced neurosensory detachment without adverse events in patients with CSC. Although these results are promising, further investigations would be helpful to understand this therapy for patients with CSC.