Efficacy Of A Tetracaine-Based Pain Management Protocol After Topography-Guided Epithelium-On Crosslinking

To explore the efficacy of a novel short-term pain-reduction protocol immediately following topography-guided epithelium-on crosslinking (epi-on CXL) with oxygen supplementation, assessing its impact on procedural comfort and post-operative recovery.

Private eye clinic in Brisbane, Australia

A prospective, single-center study to evaluate a novel pain management protocol following topography-guided epi-on CXL with the Mosaic system and oxygen googles (Glaukos, Burlington, MA) in  progressive keratoconus patients. A compounded preservative-free (PF)  tetracaine 0.1% ophthalmic formulation was administered hourly as needed post-operatively. Pain was subjectively assessed using a Visual Analog Scale (0 no pain, 10 worst possible pain) that also includes the Wong Baker Facial Pain scale. Patients are instructed to self-administer this pain questionnaire at 8pm on day 1 and at 8am/am on Days 2-4 to evaluate the effectiveness of PF-tetracaine 0.1% in alleviating post-surgical pain and eliminating the need for oral opioid analgesics.

We assessed four patients over four days following the procedure. Their mean pain scores sequentially were 1, 1.75, 1.25, and 0.75 on the first two days and the morning of the third day, dropping to 0 by day 3's evening until day 4. The peak pain experienced was a score of 3 by a single patient on the morning of day 2. Notably, by day 3 evening, all patients consistently reported a pain score of 0.  None of them required the addition of oral opiates throughout the study. Additionally, no adverse events or complications were reported.

Our study observed that a PF-tetracaine 0.1% dose, constituted at 1/10 of the strength of its commercially available counterpart, was efficacious in maintaining low mean pain scores following epithelium-on crosslinking in keratoconus patients and removed the need for oral opiates. Mean pain scores were notably low, reducing to 0 by the third day, with a peak pain of only 3 in a single case on the second day. The absence of adverse events underscores the safety of this novel short-term pain management protocol. While these results are promising, indicating the potential of PF-tetracaine 0.1% to significantly improve post-operative comfort, a larger cohort will be presented (target 30 patients) to validate these findings