Proxymetacaine shows efficacy in pain control after cross-linking
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FRANKFURT, Germany — Proxymetacaine drops are one strategy to reduce postoperative pain after epi-off cross-linking, according to a study conducted at a U.K. hospital.
Pain management is one of the challenges of epi-off CXL and can be particularly acute in pediatric patients and patients with intellectual disabilities, Mohamed Elghobaier, MD, said at the ESCRS winter meeting.
“Currently, there is no universally accepted strategy to deal with postoperative pain,” he said.
With only one case of corneal toxicity found in the literature, proxymetacaine hydrochloride is known for its safety, efficacy and tolerability.
“It comes in minims, so it’s preservative free, and it’s easily available to all patients in the NHS,” Elghobaier said.
The study, conducted at Sussex Eye Hospital in Brighton, retrospectively reviewed 223 eyes of 180 patients who underwent epi-off CXL for mild to severe keratoconus over 10 years. All patients were prescribed postoperative proxymetacaine hydrochloride drops as needed with allowed frequency up to eight times per 24 hours to control postoperative pain. Patients were seen at 1 to 2 weeks postoperatively to assess corneal healing and subjective perception of postoperative pain.
No abnormalities in corneal healing were found, including persistent epithelial defects or stromal scarring. Some stromal haze was observed, “which is universal in patients undergoing cross-linking,” Elghobaier said.
“In terms of subjective assessment of pain control, the common experience reported by patients was that pain was worst in the first 2 days,” he said. “The use of proxymetacaine helped to control it.”
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Elghobaier M, et al. Ten year’s experience of using proxymetacaine to control postoperative pain in epithelium-off crosslinking (CXL) for keratoconus. Presented at: ESCRS winter meeting; Feb. 15-18, 2024; Frankfurt, Germany.
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