Pain Management by Retrobulbar Alcohol Injection in Blind Painful Eyes Due to Late-Stage Neovascular Glaucoma

Abstract

Objective: This study aimed to evaluate the efficacy of retrobulbar alcohol injections using the verbal analog scale (VAS) in patients with blind painful eyes due to late-stage neovascular glaucoma. Methods:A total of 20 eyes with severe pain due to neovascular glaucoma were injected with 95% ethyl alcohol in the retrobulbar area. On the basis of the number of injections, the patients were separated into group 1 (1 injection) or group 2 (≥2 injections). Pain scores and complication rates were compared between the two groups. Results:The pre-injection median VAS score was 9.00±0.61 with no difference between the two groups. On post-injection day 1, no difference was found in the median VAS scores between the two groups, although significant intergroup differences appeared at 1 and 6 months. Seven patients with VAS scores ≥5 in the follow-up were given additional injections. Four patients whose pain was not relieved after three injections underwent evisceration after 6 months. The median VAS scores were significantly lower in all patients at 12 months compared with the baseline. No difference was observed in the median VAS scores between the groups at the final follow-up. Complications included ptosis in five eyes and severe conjunctival chemosis in nine eyes. Conclusion:Retrobulbar alcohol injection is a safe and effective method for managing patients with neovascular glaucoma having severe pain that is refractory to medical treatment.

A Review of Neovascular Glaucoma: Etiology, Pathogenesis, Diagnosis, and Treatment

“…Since NVG is often resistant to any treatment, its progression often leads to blindness and unbearable eye pain. In exceptional cases, when the IOP is already decompensated, the eye is painful and blind, enucleation should be considered [79][80][81].…”