Phantom pain after eye amputation

Abstract

ABSTRACT.Purpose: To characterize the quality of phantom pain, its intensity and frequency following eye amputation. Possible triggers and relievers of phantom pain are investigated. Methods: The hospital database was searched using surgery codes for patients who received ocular evisceration, enucleation, orbital exenteration or secondary implantation of an orbital implant in the period between 1993 and 2003. A total of 267 patients were identified and invited to participate; of these, 173 agreed to participate. These patients' medical records were reviewed. A structured interview focusing on pain was conducted by a trained interviewer. Results: Of the 173 patients in the study, 39 experienced phantom pain. The median age of patients who had experienced phantom pain was 45 years (range: 19-88). Follow-up time from eye amputation to participation in the investigation was 4 years (range: 2-46). Phantom pain was reported to be of three different qualities: (i) cutting, penetrating, gnawing or oppressive (n = 19); (ii) radiating, zapping or shooting (n = 8); (iii) superficial burning or stinging (n = 5); or a mixture of these different pain qualities (n = 7). The median intensity on a visual analogue scale, ranging from 0 to 100, was 36 (range: 1-89). One-third of the patients experienced phantom pain every day. Chilliness, windy weather and psychological stress ⁄ fatigue were the most commonly reported triggers for pain. Conclusions: Phantom pain after eye amputation is relatively common. The pain appears to be similar to the phantom pain suffered by limb amputees. Patients should be informed about this potential complication before surgery.

Literature Review of Recombinant Tissue Plasminogen Activator Used for Recent-Onset Submacular Hemorrhage Displacement in Age-Related Macular Degeneration

“…Fifteen studies reported intravitreal injection of both rtPA and gas [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]; one of these 15 studies incorporated the results of its own, older article [32,39]. Five studies reported intravitreal rtPA and intravitreal anti-VEGF agents and gas injections [11,12,13,44,45]. In 4 of these 5 studies, next to the rtPA, anti-VEGF agents were administered during surgery; in the fifth study, anti-VEGF was administered during the 4- to 6-week interval after surgery, if clinically indicated [45].…”

“…Vitreous hemorrhage rate ranged from 0–45% in group 1 [25,27,28,29,30,31,32,33,34,35,37,38,40,41,42,43],and 0–43% in group 2 [11,12,13,24,44,45 ](table 3). …”

“…Five studies reported intravitreal rtPA and intravitreal anti-VEGF agents and gas injections [11,12,13,44,45]. In 4 of these 5 studies, next to the rtPA, anti-VEGF agents were administered during surgery; in the fifth study, anti-VEGF was administered during the 4- to 6-week interval after surgery, if clinically indicated [45]. Four other studies reported the combination of vitrectomy, subretinal rtPA application and air tamponade [7,8,9,46]; in one of these studies, intravitreal anti-VEGF agents were only administered postoperatively, if required by the study protocol [46].…”

“…One of these studies administered anti-VEGF only postoperatively in 8 out of 53 patients [26]. One study employed intravitreal rtPA with and without intravitreal gas injection [28]. Fifteen studies reported intravitreal injection of both rtPA and gas [29,30,31,32,33,34,35,36,37,38,39,40,41,42,43]; one of these 15 studies incorporated the results of its own, older article [32,39].…”

“…The less invasive group had a range of 50–100% complete displacement rate (n = 467) [11,12,13,24,25,29,30,31,32,33,34,35,37,38,40,42,44,45] while the most invasive group had a range of 53–100% displacement rate (n = 194, including 28 REH patients) [5,6,7,8,9,10,14,46]. The range of recurrence of submacular hemorrhage was 0–27% in both the less invasive and most invasive group.…”