TEN-YEAR’S EXPERIENCE OF USING PROXYMATACAINE TO CONTROL POSTOPERATIVE PAIN IN EPITHELIUM-OFF CROSSLINKING (CXL) FOR KERATOCONUS

To evaluate the efficacy and safety of using the preservative free topical anaesthetic drops; proxymetacaine hydrochloride (Minims, 0.5% w/v, Bausch & Lomb, UK) to control postoperative pain associated with epithelium-off corneal crosslinking (CXL) for keratoconus.

Sussex Eye Hospital, Brighton, UK

An observational study of 223 eyes of 180 patients with mild to severe keratoconus with full documentation of the disease progression, intraoperative notes of the CXL procedure and postoperative reviews. All patients have undergone epithelium-off CXL as Epithelial removal was performed using 70% alcohol and 2% chlorhexidine gluconate wipes (Clinell, GAMA Healthcare, UK) for 10–20 seconds. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 minutes (Vibex Rapid; Avedro, Inc.), then continuous UV-A light (Avedro KXL system; Avedro, Inc.) for 30 minutes at 3 mW/cm2 intensity and 5.4 J/cm2 energy. All patients were prescribed postoperative proxymetacaine hydrochloride PRN with allowed frequency up to 8 times per 24 hours to control the expected postoperative pain. Patients were reviewed routinely 1-2 weeks postoperatively for complete examination including assessment of delayed corneal healing and for removal of the bandage contact lens.

Mean age was 24.9±8.6 years (range: 13-38 years). Male patients were 72%. On their planned first postoperative visit, we found 0% of corneal healing abnormalities such as persistent epithelial defects, epithelial irregularities and early postoperative stromal haze. All patients subjectively reported that proxymetacaine drops helped them to control the postoperative pain particularly on the first 48 hours.

In our observational retrospective study, we have found that our postoperative treatment protocol that includes Proxymetcaine drops helped our patients to control postoperative pain without any complications.