Surgeon: Pain control key to maximizing surface ablation outcomes

NEW YORK — Minimizing postoperative pain and optimizing epithelial healing are keys to successful refractive surgical surface ablation outcomes, according to a surgeon here.

William B. Trattler, MD, discussed his clinical techniques for reducing patients' pain after surface ablation at the OSN New York Symposium. Such strategies will be increasingly important because the surface ablation market is projected to grow, he noted.

"We are seeing a huge increase in the growth of surface ablation over the past few years," Dr. Trattler said. "In the spring of 2006, 16.7% of all laser refractive surgeries were surface ablations, and the number is growing."

The preoperative evaluation is particularly important for maximizing outcomes, Dr. Trattler said. Specifically, the surgeon should look for signs of dry eye and treat accordingly.

"Identify dry eye ahead of time, start Restasis drops (cyclosporine ophthalmic emulsion, Allergan) or put in punctal plugs. By pre-treating your dry eye patients you can help reduce pain," he said.

When patients develop postoperative pain, surgeons have several pharmaceutical options available, including topical and systemic nonsteroidal anti-inflammatory drugs and steroids, Dr. Trattler said.

"Oral NSAIDs are very effective, and perhaps other medications such as oral prednisone or oral neurontin can also be helpful for controlling pain," he said. He also suggested using topical ketorolac 0.4%.

"Diluted tetracaine 0.05% is another agent that has been quite helpful for my patients to control discomfort after surface ablations," he said. He urged surgeons to order diluted tetracaine from a compounding pharmacy, rather than mixing it themselves, to reduce the risk of infection and subsequent litigation.

Another option is chilling the cornea with chilled balanced salt solution immediately after ablation, which has been shown to decrease pain scores, Dr. Trattler said.