<p>Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs</p>

Abstract

Purpose: To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal antiinflammatory drugs (NSAIDs). Patients and Methods: A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery. Results: The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p<0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p<0.0001). Pain scores 24-72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups. Conclusion: Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24-72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.

Twelve-Month Outcomes of the Wavefront-Optimized Photorefractive Keratectomy for High Myopic Correction Compared with Low-to-Moderate Myopia

“…33,34 Another drawback of PRK compared to LASIK is postoperative pain particularly for the first 72 hours due to epithelial removal. 35 Bandage soft contact lenses speed the epithelialization and pain relief after PRK. Medications commonly used post-PRK include lubricants, topical corticosteroids, topical and oral NSAIDs, and oral analgesic drugs.…”

Two-year successful results of femto-LASIK in steep and opacified corneas

“…LASIK was proposed as a refractive error treatment because we estimated that surface ablation could be associated with significant regression of the refractive error, corneal haze, epithelial healing abnormalities, and pain [8,9]. In addition, there was a higher risk of corneal haze due to the high levels of ultraviolet radiation exposure in the sunny region of southern Egypt [10].…”

Resveratrol increases tear production and spontaneous ocular pain after corneal abrasion in male, but not female, rats using a preclinical model of photorefractive keratectomy (PRK)

“…In PRK, alcohol is used to soften the corneal epithelium and then mechanical debridement is used to remove the epithelium. As a result, corneal sensory nerves are severed in the abraded area, causing acute pain, photophobia and alterations in tear production leading to sensations of dryness, burning, and grittiness in postoperative PRK patients (Beheshtnejad et al, 2015;Bower et al, 2015;Colin and Paquette, 2006;Gaeckle, 2021;Palochak et al, 2020;Quinto et al, 2008;Ripa et al, 2020;Shetty et al, 2019;Zarei-Ghanavati et al, 2019). There has been inconsistent and poor clinical management of post-operative PRK symptoms, usually with oral and topical non-steroidal anti-inflammatory drugs (NSAIDs), narcotics or corticosteroids (Javadi et al, 2008;O'Brart et al, 1994;Palochak et al, 2020;Ripa et al, 2020;Shetty et al, 2019).…”

“…Although PRK has been performed for decades, postoperative pain and other ocular symptoms continue to be a challenge for clinicians. Clinical studies of PRK have documented similar increases in postoperative pain and photophobia as measured subjectively by patients on ordinal scales, such as the visual analog scale (VAS) for pain (Colin and Paquette, 2006;Gaeckle, 2021;Palochak et al, 2020;Ripa et al, 2020;Shetty et al, 2019;Zarei-Ghanavati et al, 2019). Clinical signs of dysfunctional tear syndrome or dry eye, as measured with the Schirmer's test and described by patients as burning, dryness, irritation and the sensation of a foreign body in the eye are also increased in PRK patients (Beheshtnejad et al, 2015;Bower et al, 2015;Quinto et al, 2008).…”

“…The effectiveness of these drugs as analgesics post-PRK needs to be weighed against the side effects that often accompany them. For example, corticosteroids can cause an increase in intraocular pressure and increased risk of developing glaucoma (Javadi et al, 2008;O'Brart et al, 1994), oral NSAIDs can cause gastrointestinal irritation and ulcerations, topical NSAIDs can lead to delayed epithelial wound healing, punctate keratitis and corneal melt (Ripa et al, 2020;Shetty et al, 2019) and narcotics carry the risk of dependence and misuse as well as respiratory depression and gastrointestinal effects (Palochak et al, 2020;Volkow et al, 2019).…”