A Painless Trans-Photo-Refractive Keratectomy: A Mirage?

Objectives:

to describe a rare case of trans-photo-refractive keratectomy

(trans-PRk) with minimal pain after successful ocular ablation.

is about a patient with successful Myopia surgery through trans-PRk who felt no pain after the operation, from the first day on.

observation :

is about a 20-year-old patient with myopia and astigmatism in both eyes:

 right eye = -3 (-1 to 5 degrees),

 left eye = -2 (-1.5 to 180 degrees). 

The topographic cornea map finds a pachymetery of 565 microns on the right eye and 549 microns on the left eye. 

The patient underwent successful 

trans-photo-refractive keratectomy with Schwind Amaris* and was followed by topical mitomycin C diluted, salt-cold serum wash, and therapeutic lenses.

 Then the patient received topical corticosteroid treatment (Dexamethasone), and systemic corticosteroid treatment (Prednisone). 

On discharge, besides the corticosteroid treatment and the wetting agents (Hyaluronic acid), class I analgesics (Paracetamol) were prescribed. 

The pain was rated on the NRS scale and was unusually non-existant from the first to the fifth day after operation. 

The analgesic effect of the Pregabalin was directly implicated in this case.

 Discussion : 

The pain after trans-photo-refractive keratectomy (PKR) surgery is almost constant and intense, often resistant to various analgesic protocols. This anecdotal case of analgesia after trans-PKR is most probably linked to the chronic usage of Pregabalin by the patient. The use of this drug, well-known for its effect on neuropathic pain, is mentioned sparsely in literature for its analgesic effect in ophthalmological surgeries.

The management of pain after trans-photo-refractive keratectomy is delicate and requires an effective medication, which is often inadequate. The addition of Pregabalin seems effective and opens the door to new perspectives in analgesics.