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Preoperative topical NSAID significantly reduces pain 1 day after PRK
J Cataract Refract Surg.2011;37(4):633-637.
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Preoperative administration of topical diclofenac enabled significant pain management in patients undergoing PRK, a study found.
"There are many techniques and methods for the management of postoperative pain; of these, pre-emptive analgesia is of great interest," the study authors said. "The effects of a preoperative analgesic regimen remain controversial, and developing effective treatments for postoperative pain is a goal of widespread clinical study."
Diclofenac 0.1% and ketorolac 0.4% and 0.5% are approved for pain management after refractive surgery.
The randomized masked clinical trial included 140 eyes of 70 patients who underwent bilateral PRK. Mean patient age was 26.14 years.
Patients received one drop of diclofenac 0.1% in one eye and one drop of artificial tears as a placebo in the other eye 2 hours before PRK. After surgery, both eyes of each patient received topical diclofenac every 6 hours for 2 days.
At 1 and 2 days postoperatively, patients rated pain in each eye on an 11-point numeric scale.
At 24 hours after surgery, patients reported pain scores of 0.97 in eyes pretreated with diclofenac and 2.09 in eyes pretreated with placebo. The between-eye differences in pain scores were clinically and statistically significant (P = .018). However, the between-eye differences in pain scores were statistically insignificant at 2 days.
Results showed no serious complications such as delayed epithelial healing or corneal haze in eyes pretreated with diclofenac or those that received placebo, the authors reported.
The authors have performed an interesting prospective analysis of the effect of a preoperative topical NSAID on controlling pain following PRK. Pain is a common complaint following PRK, and the use of NSAIDs is the most common therapeutic approach to controlling this pain. NSAIDs work by inhibiting the production of prostaglandins that contribute directly to the inflammatory pathway and pain. Because NSAIDs have no effect on preformed prostaglandins, the concept of pretreating with an NSAID makes sense and has long been a standard with cataract surgery. This study supports the use of pretreating prior to PRK as well.
– Eric D. Donnenfeld, MD
OSN
Cornea/External Disease Board Member
Disclosure: Dr. Donnenfeld reported
financial relationships with Alcon, Allergan and Bausch + Lomb.