Postoperative Pain Management After Trans-Prk: Standard Vs Enhanced Interventions-A Double Blinded Randomised Controlled Trial
Published 2024 - 42nd Congress of the ESCRS
Reference: PO1265 | Type: Free paper | DOI: 10.82333/h2zv-rp41
Authors: Astha Gupta* 1 , Ramesh Babu 1 , Subashini Kaliaperumal 1 , Sandeep Devan 1 , Aarthy G 1
1Ophthalmology,JIPMER,Pondicherry,India
Purpose
Refractive surgery, such as LASIK and PRK, corrects vision errors by reshaping the cornea. TransPRK, a surface treatment method, is gaining popularity due to advancements in technology. However, postoperative pain management remains a concern. Bandage Contact Lenses (BCL) soaked in ketorolac are commonly used to alleviate pain. This study aims to evaluate the effectiveness of BCL, ketorolac, and temperature control in managing pain after TransPRK. Additionally, we explore the impact of NSAIDs on corneal re-epithelialization post-transPRK. Understanding these factors can optimize postoperative care and enhance patient outcomes.
Setting
Barraquer Laser refractive centre, Department of Ophthalmology, JIPMER
Methods
A double-blinded randomized clinical trial enrolling 118 myopic males and females involved 4 intervention groups: conventional room temperature BCL, chilled BCL, BCL soaked in ketorolac 0.4% (room temperature), and chilled BCL soaked in ketorolac 0.4%. Inclusion criteria encompassed myopia or myopic astigmatism (-1.00 to -5.00D spherical equivalent). Corneas with residual stromal bed thickness <325 μm, tissue ablation exceeding 40% and patients seeking monovision correction were excluded.
On the 3rd postoperative day, the Wong-Baker Faces pain scale was used to quantify pain in the treatment groups. Corneal re-epithelialization and corneal haze were graded using the ocular surface staining score and Fantes et al’s scale respectively.
Results
There were 31 patients in conventional BCL group, 32 in BCL soaked ketorolac group, 28 in chilled BCL group and 27 in chilled BCL soaked in ketorolac group.
The mean pain scores were 2.54 ± 1.05(SD), 2.25 ± 1.19; 2.32 ± 1.21; 2.29 ± 0.86, respectively; (p = 0.38).
The mean ocular surface staining scores were 0.5 ± 0.81, 0.64 ± 1.00, 0.45 ± 0.94, 0.4 ± 0.76 respectively (p = 0.08).
The mean score for corneal haze was 0.070 ± 0.189, 0.104 ± 0.256, 0.078 ± 0.23, 0.093 ± 0.209 respectively (p= 0.7).
Conclusions
The pain scores were less with the enhanced interventions compared to standard method, but this was not statistically significant. NSAIDs do not seem to hinder corneal re-epithelialization. No significant difference in development of corneal haze was observed between various intervention groups.