The treatment of pain following excimer laser photorefractive keratectomy: additive effect of local anesthetic drops, topical diclofenac, and bandage soft contact.

BACKGROUND AND OBJECTIVE: Post-operative pain is a transient but undesirable side effect of photorefractive keratectomy (PRK). Pain control after excimer laser PRK was assessed in 112 eyes that were divided into 6 pain management groups.

PATIENTS AND METHODS: "Pain at its worst" was measured using a visual analog scale. The groups are arranged in order, Group 6 having experienced the most effective relief of pain and Group 1 the least relief of pain: 1) Topical amethocaine/tetracaine, 2) Topical amethocaine/tetracaine plus bandage contact lens, 3) Topical diclofenac, 4) Topical diclofenac plus bandage contact lens, 5) Topical amethocaine/tetracaine plus diclofenac, and 6) Topical amethocaine/tetracaine, diclofenac plus bandage contact lens. All patients were given 10 tablets of co-dydramol (10 mg dihydrocodeine and 500 mg paracetamol per tablet). They were to be used every 4 hours, but patients were specifically instructed not to take the tablets unless the topical pain management was inadequate for their needs.

RESULTS AND CONCLUSION: Group 6 was dramatically better than any other group. In fact, 31% of Group 6 patients had no pain whatsoever. Removing any one of the 3 pain management tools resulted in much less pain control. Day 1 pain was also much more effectively controlled by the Group 6 management compared with those of the other groups. Group 6 patients took fewer co-dydramol tablets than any of the other groups. In addition, Group 6 scored best n several other areas that were studied: a) Day 1 light sensitivity; b) Day 1 tearing; c) Day 1 drowsiness; and d) number of hours slept on the first night. The epithelium healed in all patients but one Group 5 and one Group 6 patient had an epithelial defect for longer than 7 days. There was no instance of infectious keratitis, nor was there an instance of the sterile keratitis that has been associated with the use of topical non-steroidal anti-inflammatory drops.