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Global Translational Medicine Neuropathic pain after 23-gauge sclerotomy

A B C

D E F

Figure 1. Individual scatterplots of symptoms of ocular neuropathic pain before and after surgery. No significant alternation was observed in eye pain (A),
photophobia (B), tearing (C), facial pain (D), facial numbness (E), and foreign body sensation(F)

baseline characteristics factors, only the level of education nerve and travel anteriorly to around the ciliary body. The
and history of migraine could predict post-operative small-gauge sclerotomies can injure these nerve endings. In
overall pain score. In addition, we observed a significant addition, conjunctival manipulation, desiccation, exposure
increase in analgesics consumption 2 months following to microscope light, and toxicity of povidone-iodine or
surgery. Furthermore, patients using analgesics after post-operative topical drugs can induce ocular surface
surgery have reported worse scores on quality-of-life- abnormalities. A study conducted in 2013 investigated ocular
related items. Patients who reported ocular and facial pain pain after a conventional 20-gauge pars plana vitrectomy and
as well as photophobia before surgery were more likely to reported that the frequency of ocular pain increased from
consume analgesics after surgery. Severing the enriched 4.6% before surgery to 49.4% the day after surgery which
nerve plexus in surgeries involving corneal incisions has then gradually decreased. In this study, 12.6% of patients
been shown to induce ocular neuropathic pain. However, reported persistent ocular pain at the final report which
few studies exist that investigate ocular pain following was done 2 months after surgery. Symptoms of foreign body
surgeries involving solely scleral incisions. 12,13 sensation were found in 25% of patients. The insignificant
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Compared to the cornea which has the highest nerve alteration of pain scores in our study may be related to the
density in the body, the sclera is less sensitive due to its use of a smaller-gauge device to pierce the sclera with the
lower nerve density and the less exposed nerves which induction of fewer nerve endings destruction. Interestingly,
are located far from the surface. The anterior sclera is a retrospective study comparing 20-gauge versus 23-gauge
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innervated by two long posterior ciliary nerves which are vitrectomy showed that the 23-gauge vitrectomy group
branches of the ophthalmic division of the trigeminal experienced less discomfort of the eye (0.96 weeks vs.
nerve. These nerves pierce the sclera adjacent to the optic 2.4 weeks), less pain and sleep disturbance, and consumed
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Volume 3 Issue 2 (2024) 4 doi: 10.36922/gtm.1770