A randomized, double-masked, clinical study of the efficacy of four nonsteroidal anti-inflammatory drugs in pain control after excimer laser photorefractive keratectomy

Corneal Ulceration and Perforation With Ketorolac Tromethamine (Acular®) Use After PRK

“…4 Some physicians prescribe ketorolac tromethamine with 1 drop given immediately after photorefractive keratectomy followed by 1 drop 4 times daily for varying periods, ranging from 3 days to more than a month. Administration of the NSAID throughout the first 3 postoperative days is thought to be critical in achieving the desired reduction in pain, discomfort, and inflammation.…”

“…[1][2][3][4] Reported complications associated with NSAID use include decreased corneal sensation, superficial punctate keratitis, subepithelial infiltrates, persistent epithelial defects, corneal ulceration, and corneoscleral melting. [5][6][7][8][9] The initial cases of corneal ulceration associated with NSAIDs were reported with postoperative topical use of diclofenac sodium (Falcon Ophthalmics, Inc, Fort Worth, TX; and Voltaren Ò , Ciba Vision Ophthalmic, Atlanta, GA).…”

Effect of nepafenac sodium 0.1% on delayed corneal epithelial healing and haze after photorefractive keratectomy

“…In their masked controlled study, topical diclofenac sodium 0.1%, flurbiprofen sodium 0.03%, and prednisolone sodium 1% were compared in rabbits with epithelial scrape wounds that showed delayed healing time; however, there was no effect on the corneal stroma. Vetrugno et al 10 compared 4 treatment arms (diclofenac, flurbiprofen, ketorolac, and indomethacin) in a randomized double-masked placebo-controlled clinical study that found all NSAIDs except flurbiprofen slightly prolonged the epithelialization rates (P!.001).…”

Efficacy of Extended-Release Oral Diclofenac in Postoperative Pain Management After Photorefractive Keratectomy

“…In PRK, the corneal epithelium is debrided before ablation, which exposes numerous highly sensitive nerve endings and may lead to severe pain and neurogenic inflammation. 1 Many studies have addressed the management of pain after PRK surgery, focusing primarily on topical analgesic methods. A few studies have evaluated the effects of oral medications, such as gabapentin.…”

“…3 However, topical NSAIDs also are associated with many disadvantages, including a delay in epithelial healing and possibility of corneal melting. 1 To date, there is no consensus as to the most effective treatment for postoperative pain with PRK surgery, and pain remains an important limitation to the usefulness of this procedure. 2,3 The present study was designed to determine the effect of the preoperative administration of the NSAID diclofenac in extended-release form on post-PRK pain control, as compared with the administration of other oral analgesics (acetaminophen and ibuprofen).…”