Postoperative Pain Management New Protocole In Photorefractive Keratectomy Using Topical Standard Protocole Versus Oral Systemic Corticosteroid Drugs.

To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral corticosteroids versus topical treatments.

Department of Ophthalmology, Hospital Quironsalud, Marbella.

A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 50 subjects. Patients were randomized to either topical Bromfenac 0.9 mg/ml every 6 hours combined with topical Prednisolone acetate or oral Deflazacort 30 mg added to the topical protocol of bromfenac and topical prednisolone acetate every 24h hours, tapering during six days (80 mg -60 mg -40 mg -20 mg -10 mg - 5 mg /day) following PRK, beginning two hours before the surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) two days after surgery.

The peak pain scores of the first day post-operative were significantly lower in the oral Deflazacort group (mean 3.36, SD 1.64) compared to the topical NSAID and Prednisolone group (mean 7.96, SD 1.04lllll) (p<0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly lower in the oral Deflazacort group (mean 1.56, SD 0.4f4) compared to the topical NSAID and Prednisolone group (mean 4.20, SD 1.8) (p<0.0001).

Adding Deflazacort 30 mg to the topical protocol of bromfenac and topical prednisolone acetate every 24h hours, tapering during six days (80 mg - 60 mg - 40 mg - 20 mg -10 mg - 5 mg /day) decreases the pain significantly after PRK. This additional observation may be helpful in understanding, preventing, and treating post-PRK pain.