Severe tianeptine withdrawal symptoms managed with medications for opioid use disorder: a case report.

INTRODUCTION: Tianeptine is a tricyclic antidepressant (TCA) without FDA-approval that acts on dopamine and norepinephrine. It has opioid agonist activity and is increasingly being used for recreational purposes to achieve an opioid-like anxiolytic effect. This can lead to clinical addiction with subsequent withdrawal symptoms resembling symptoms of opioid withdrawal. There are limited cases detailing the management of tianeptine withdrawal. CASE SUMMARY: We present the case of a 38-year-old male with chronic tianeptine use admitted to the Intensive Care Unit for treatment of encephalopathy and vital sign changes due to intake of multiple substances and suspected tianeptine withdrawal. He reported 8 to 20 g daily use of tianeptine. He was initially managed with buprenorphine/naloxone and supportive care and reported improvement in withdrawal symptoms within three days of admission. We trialed transitioning to methadone, given possible long-term benefit due to TCA-like properties, but this was discontinued due to difficulty with access on discharge. He was provided with a bridge prescription for buprenorphine/naloxone to cover until his outpatient follow-up visit and was subsequently discharged home. CONCLUSION: This case demonstrates management of tianeptine withdrawal in a hospitalized patient presenting with significant daily use not reported previously in the literature.

Phacofragmentation as an Effective Tool for Removal of Silicone Oil Adherent to Posterior Chamber Intraocular Lenses.

BACKGROUND/PURPOSE: To assess usefulness of phacofragmentation probe in the removal of silicone oil (SO) adherent to intraocular lenses (IOLs) during a SO removal procedure. METHODS: A 20-gauge (G) phacofragmentation probe was used to emulsify and remove SO adherent to IOLs during 23-G vitrectomy for SO removal. The superotemporal 23-G cannula was removed, and 20-G sclerotomy was made by using a 20-G MVR blade. RESULTS: In all cases used, SO adherent to the posterior surface of posterior capsule IOLs and anterior chamber IOLs was easily removed using a phacofragmentation probe. No intraoperative complications or IOL damage were noted. CONCLUSION: We describe a simple, quick and reliable method of SO removal from all types of IOLs by using a phacofragmentation probe during SO removal surgery. This simple method can prevent IOL removal and replacement due to adherent SO bubbles in pseudophakic eyes that were previously filled with SO.