Postoperative Proxymethacaine In Crosslinking (Cxl) For Keratoconus: 10 Years Experience

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 CXL for keratoconus.

Sussex Eye Hospital, University Hospitals Sussex NHS Foundation Trust, Brighton, United Kingdom

A chart review of 223 eyes (180 patients) with mild to severe keratoconus. All patients have undergone epi-off CXL as Epithelial removal was performed using 70% alcohol and 2% chlorhexidine gluconate wipes for 10–20 seconds. CXL was completed by applying dextran-free riboflavin (0.1%) for 10 minutes, then continuous UV-A light 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 upto 8 times per 24 hours to control the expected postoperative pain. Patients were reviewed routinely 1-2 weeks postoperatively for examination including assessment of delayed corneal healing and for removal of the bandage contact lens.

Mean age was 24.9 ± 8.6 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 major complications; mainly delayed healing. Further studies including control candidates will be needed in the future to confirm our clinically satisfactory results.