Proceedings of the RAMI Section of Ophthalmology Meeting, Friday 7th
April 2017 in the Killashee House Hotel, Naas
Royal Academy of Medicine in Ireland 2018
Randomised controlled trial to assess efficacy of music in reducing
pain in panretinal photocoagulation for treatment of diabetic
C Quigley, R Ellard, H Al Arreyedh, T Droney, F Harney, D Townley
Dept. of Ophthalmology, Galway University Hospital
Background: Panretinal Photocoagulation (PRP) reduces blindness by
50% in patients with proliferative diabetic retinopathy. Pain during PRP is
known to occur in most patients, to a greater or lesser extent. When
severe, patient discomfort may necessitate general anaesthesia, with in-
herent risk of morbidity and mortality. The efficacy of music in reducing
pain is unknown.
Aims: The aim of this study is to assess the efficacy of music via RCT of
classical music versus usual laser, and also to identify the variables asso-
ciated with increased pain.
Methods: This was a single centre prospective randomized con-
trolled trial. Research ethics board approval was granted prior to
initiation, participants were recruited between September and
December 2016. Participants were randomized, and demographic
details were recorded. Outcome variables included numeric pain
score immediately after and again 24 hours post laser, and vital
signs, including heart rate and blood pressure before and imme-
diately after laser. Ability of the patient to follow the laser
physician's directions was assessed. Logistic regression was used
in pain score analysis, unadjusted and adjusted for other factors
predictive of pain. Participants were given the opportunity to give
feedback about the laser treatment.
Results: A total of 27 participants were recruited into the study,
including 15 males (55.6%), mean age 51± 15 years, of whom 18
were randomly allocated to the music group, and 9 to the usual
laser group. Just over half of participants reported pain immedi-
ately after laser, n= 14 (51.9%), amongst whom the median pain
score was 5 out of 10 (IQR: 3-6). One day later pain was report-
ed in a further n=6 participants (22%), of whom the median pain
score was again 5 out of 10 (IQR: 3-6). Of the total 27 partici-
pants, 26 (96%) could follow all directions of the physician car-
rying out the laser. Music was not associated with pain score at
either time point, however of those who gave feedback (n=9),
improved experience with music was reported in n=6 (66%).
Pain immediately after laser was associated with total laser energy
dispensed (p=0.04), and females reported higher pain scores; 6.6
± 1.7 versus 2.3 ± 1.5 in males (p =0.004).Painat24hourswas
also associated with total laser energy dispensed (p=0.004) and
with female sex (p=0.05). After adjustment for all other variables
measured, these associations were removed. Overall there was no
significant difference in vital signs, including heart rate and blood
pressure, before and after the laser, however change of blood
pressure, was associated with total energy dispensed, which for
systolic and mean arterial blood pressure persisted on adjustment
(p=0.03 and p=0.0004). Significant adverse outcomes occurred in
two participants, one of whom fainted during the procedure, and
the second attended an out of hours General Practitioner service
for injectable analgesia the evening following laser, due to intrac-
table pain. Both patients were in the music group.
Conclusions: Laser PRP can be associated with patient discomfort, with
higher levels of pain reported in females, in keeping with prior studies.
Higher reported pain, and greater change in blood pressure, was associ-
ated with total energy dispensed. Classical music was not effective in
reducing reported pain.
Sudden loss of vision
M Mohamed, S Pharrell, A Cullinane
Ophthalmology Dept., Cork University Hospital, Cork
A 52-year-old male presented to the Eye Casualty complaining of loss of
central vision in the left eye since waking, he experienced one episode of
photopsia the previous night. He had a history of intermittent chronic
cough and pyrexia for 6 weeks and was receiving oral ciprofloxacin for
respiratory tract infection diagnosed by his GP one week prior to
On examination, his best corrected visual acuity was 6/5 in the
right eye and 6/60 in the left eye. Anterior segment examination
and intraocular pressure were normal. Dilated fundus examination
revealed white eliptical subfoveal elevated choroidal lesion
surrounded by a rim of hemorrhage in the left eye. There was
no vitritis present.
Within 12 hours, signs of vitritis developed around the choroidal lesion.
At 48 hours the vision reduced to hand motion and the patient reported
pain in the eye, the vitritis became more dense, (grade 4+) with loss of
fundal view. Empirical intravitreal antibiotics administered with ceftazi-
dime and vancomycin, topical chloramphenicol, dexamethasone and
cyclopentolate drops started.
Topical dexamethasone was tapered over a period of two months.
Six months following presentation, the best corrected visual acuity
remained 1/60 in the eye, there were no signs of active inflammation in
the eye and posterior synechiae had resolved, however, a pale elevated
lesion persisted at the macula.
Here we discuss his investigations findings and management.
Irish Journal of Medical Science (1971 -) (2018) 187 (Suppl 2):S7–S10