Assessment of ocular neuropathic pain following vitreoretinal surgery using 23-gauge sclerotomy
![](https://article.accscience.com/imageFile/by.png)
Ocular neuropathic pain refers to persistent post-operative perception of ocular discomfort in the absence of painful stimuli. This study investigates persistent ocular pain following 23-gauge pars plana vitreoretinal surgery. In the present study, patients who underwent either 23-gauge vitrectomy or silicone oil removal, under local or general anesthesia, were included. The symptoms of ocular neuropathic pain were evaluated using the brief pain inventory questionnaire before and 2 months after surgery. In addition, the impact of reported ocular symptoms on quality of life was assessed. We also evaluated the correlation between ocular pain and factors such as patient demographics and underlying systemic conditions. This study includes 75 eyes of 75 patients with an average age of 58.93 ± 12.05 years. Of the included patients, 31 (41.3%) were female. Among the participants, 67 (89.3%) underwent pars plana vitrectomy, and 8 (10.7%) experienced silicone oil removal surgery. Analysis using paired t-test or Wilcoxon signed-rank test, based on data normality, indicated no significant change in eye pain scores 2 months after surgery. However, the percentage of patients using analgesics increased from 4% before surgery to 17.3% 2 months after surgery (P = 0.021). Furthermore, based on a linear regression model, patients who reported increased analgesic usage 2 months after surgery also scored worse on the quality-of-life questionnaire (P < 0.05). We also found that those who reported ocular pain, facial pain, and photophobia before surgery had a higher likelihood of using analgesics after surgery (P = 0.03, 0.003, and 0.001, respectively). In addition, regression analysis revealed that patients with migraine headaches and lower levels of education were more likely to develop eye symptoms postoperatively (P = 0.017 and 0.044, respectively). In conclusion, surgeries involving 23-gauge scleral incisions do not significantly induce ocular neuropathic pain within 2 months after surgery. However, there is an observed increase in the use of analgesics following surgery.
- Raja SN, Carr DB, Cohen M, et al. The revised International Association for the Study of Pain definition of pain: Concepts, challenges, and compromises. Pain. 2020;161(9):1976-1982. doi: 10.1097/j.pain.0000000000001939
- Schug SA, Lavand’homme P, Barke A, et al. The IASP classification of chronic pain for ICD-11: Chronic postsurgical or posttraumatic pain. Pain. 2019;160(1):45-52. doi: 10.1097/j.pain.0000000000001413
- Ebrahimiadib N, Yousefshahi F, Abdi P, Ghahari M, Modjtahedi BS. Ocular neuropathic pain: An overview focusing on ocular surface pains. Clin Ophthalmol. 2020;14:2843-2854. doi: 10.2147/OPTH.S262060
- Rosenthal P, Borsook D. Ocular neuropathic pain. Br J Ophthalmol. 2016;100(1):128-134. doi: 10.1136/bjophthalmol-2014-306280
- Craig JP, Nelson JD, Azar DT, et al. TFOS DEWS II report executive summary. Ocul Surf. 2017;15(4):802-812. doi: 10.1016/j.jtos.2017.08.003
- Kalangara JP, Galor A, Levitt RC, Felix ER, Alegret R, Sarantopoulos CD. Burning eye syndrome: Do neuropathic pain mechanisms underlie chronic dry eye? Pain Med. 2016;17(4):746-755. doi: 10.1093/pm/pnv070
- Galor A, Zlotcavitch L, Walter SD, et al. Dry eye symptom severity and persistence are associated with symptoms of neuropathic pain. Br J Ophthalmol. 2015;99(5):665-668. doi: 10.1136/bjophthalmol-2014-306057
- Woolf CJ. Central sensitization: Implications for the diagnosis and treatment of pain. Pain. 2011;152(3):S2-S15. doi: 10.1016/j.pain.2010.09.030
- Kroenke K, Wu J, Bair MJ, Krebs EE, Damush TM, Tu W. Reciprocal relationship between pain and depression: A 12-month longitudinal analysis in primary care. J Pain. 2011;12(9):964-973. doi: 10.1016/j.jpain.2011.03.003
- Stapleton F, Alves M, Bunya VY, et al. Tfos dews ii epidemiology report. Ocul Surf. 2017;15(3):334-365. doi: 10.1016/j.jtos.2017.05.003
- Majedi H, Dehghani SS, Soleyman-Jahi S, et al. Validation of the Persian version of the brief pain inventory (BPI-P) in chronic pain patients. J Pain Symptom Manage. 2017;54(1):132-138.e2. doi: 10.1016/j.jpainsymman.2017.02.017
- Yu JG, Ni F, Xiang Y, Feng YF, Wang J, Fu XA. A prospective study on postoperative discomfort after 20-gauge pars plana vitrectomy. Clin Ophthalmol. 2015;9:1379-1384. doi: 10.2147/OPTH.S87017
- Mentens R, Stalmans P. Comparison of postoperative comfort in 20 gauge versus 23 gauge pars plana vitrectomy. Bull Soc Belge Ophtalmol. 2009;311(2):5-10.
- Maurice DM. The cornea and sclera. In: Vegetative Physiology and Biochemistry. Amsterdam: Elsevier; 1962. p. 289-368. doi: 10.1016/B978-1-4832-3090-0.50013-7
- Dawson DG, Ubels JL, Edelhauser HF. Cornea and sclera. In: Adler’s Physiology of the Eye. Vol. 11. Amsterdam: Elsevier; 2011. p. 71-130.
- Hashimoto A, Sonohata M, Mawatari M. The use of oral analgesics and pain self-efficacy are independent predictors of the quality of life of individuals with rheumatoid arthritis. Pain Res Manag. 2020;2020:7409396. doi: 10.1155/2020/7409396
- Lapčević M, Vuković M, Gvozdenović BS, Mioljević V, Marjanović S. Socioeconomic and therapy factor influence on self-reported fatigue, anxiety and depression in rheumatoid arthritis patients. Rev Bras Reumatol Engl Ed. 2017;57(6):545-556. doi: 10.1016/j.rbre.2017.02.004
- Deeny MC, Al Hamdan E, Ross EL, Edwards RR, Huang CC, Jamison RN. Chronic pain, comorbid medical conditions, and associated risk factors in Kuwait: Gender and nationality differences. Pain Med. 2015;16(11):2204-2211. doi: 10.1111/pme.12840
- Dubois-Mendes S, Sá KN, Meneses F, De Andrade DC, Baptista AF. Neuropathic pain in rheumatoid arthritis and its association with Afro-descendant ethnicity: A hierarchical analysis. Psychol Health Med. 2021;26(3):278-288. doi: 10.1080/13548506.2020.1749677