EyeWorld is the official news magazine of the American Society of Cataract & Refractive Surgery.
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EW NEWS & OPINION January 2016 21 Editors' note: Drs. Sheppard and Trattler have no financial interests related to this article. best for each patient [enucleation or this type of procedure, for example]. While the procedure is straightfor- ward, there are risks that have been reported, including lid swelling and 6th nerve palsy," he added. Lessons from the Pakistan case series According to the literature, the success rate of retrobulbar alcohol injection for pain relief is variable and ranges between 20% and 87%. "The pain relief provided by retrobulbar alcohol [in this series] was rapid and long lasting with 4 patients being pain free within 1 week and all 5 at 1 year after injec- tion," the researchers reported. Such findings, they noted, are comparable to results of previously conducted studies. Although retrobulbar injections of neurolytic agents such as alco- hol seem like a simple method in controlling ocular pain, the success of the technique depends on the accuracy of how it is conducted. "The alcohol has to be injected in close proximity to the nerve fibers barring which only a dampening of nerve fiber conduction is achieved and the pain recurs with time," they explained. Postoperative complications encountered were temporary and resolved without intervention, hence not significantly adverse (i.e., anesthesia of the skin overlying the cheek, lid and brow, conjunctival chemosis and lid edema). More importantly, complications associ- ated with post-injection retrobulbar hemorrhage as in previously report- ed studies were not observed in this case series. Overall, results of the Pakistani case series emphasized the contin- ued important role of retrobulbar alcohol injection in pain relief man- agement of patients with absolute glaucoma. EW References 1. Akhtar N, et al. Pain management with retrobulbar alcohol injection in absolute glaucoma. J Pak Med Assoc. 2015 Jun;65(6): 678–80. 2. Kumar CM, et al. Retrobulbar alcohol injection for orbital pain relief under difficult circumstances: a case report. Ann Acad Med Singapore. 2006 Apr;35(4):260–5. 3. Lim KJ, et al. Retrobulbar alcohol injection for orbital pain relief in blind: a case report. European Journal of Anaesthesiology. 2014 June;31:232. 4. Olurin O, et al. Complications of retrobulbar alchohol injections. Ann Ophthalmol. 1978 Apr;10(4):474–6. Only the HOLOS IntraOp ™ Wavefront Aberrometer continuously streams patient refractive data. Meaning you'll get a non-stop look at your procedure as it changes. And see cataract surgery in a whole new light. With HOLOS, precision doesn't pause —and neither will you. Really real time. ©2015 Clarity Medical Systems Inc. PN 100331 09/15 HOLOS.com Now available in the United States Contact information Sheppard: kfowler@vec2020.com Trattler: wtrattler@gmail.com