NSAID significantly reduces pain after surface ablation

Las Vegas-Postoperative treatment with nepafenac 0.1% ophthalmic suspension (Nevanac, Alcon Laboratories) significantly reduces pain after surface ablation without delaying re-epithelialization, reported Charles D. Reilly, MD, at the Refractive Surgery Subspecialty Day program during the American Academy of Ophthalmology annual meeting.

Dr. Reilly and colleagues at Wilford Hall, Lackland Air Force Base, San Antonio, investigated the efficacy and safety of nepafenac for improving patient comfort after their laser vision correction procedures in a prospective, placebo-controlled, double-masked, randomized study. Sixty-six patients undergoing bilateral surgery were enrolled. The study population consisted of 46 males and 20 females (mean age: 32 years).

Fellow eyes were randomly assigned to treatment with nepafenac or balanced salt solution (BSS). The patients were instructed to instill the drops three times a day for 2 days postoperatively after administering all other medications.

Mean pain scores were significantly lower in the nepafenac-treated eyes compared with the BSS-treated eyes on the first postoperative day (0.76 versus 1.68; p = 0.0005) and second postoperative day (1.26 versus 2.23; p < 0.0001). No significant difference in mean pain scores between treatments was observed on the third day after surgery (0.59 versus 0.69), and all eyes were pain-free on the fourth postoperative day.

The defect in the nepafenac-treated eyes was significantly larger on the second day compared with the controls. The difference in mean defect area at that visit, however, was numerically small (<0.70 mm² ), no significant difference in defect size existed between groups on the first or third postoperative days, and closure of all defects was achieved by the fourth day after surgery in both study groups.

In the military

"In the military . . . laser refractive surgery was approved by the Air Force surgeon general in August 2000," Dr. Reilly said. "Although our refractive surgeons do all types of corneal refractive procedures, the majority are surface ablation."

Pain is the main disadvantage of PRK, he said, adding that the results of this study show that postoperative nepafenac helps to minimize that problem.

The surface ablation procedures were performed with a standardized epithelial defect created by filling an 8.5-mm well with 20% ethanol for 30 seconds. To maintain masking, the study medications were dispensed in opaque bottles. Both eyes were treated similarly with a standard postoperative regimen that included placement of a bandage contact lens, topical treatment with an antibiotic, and corticosteroid and preservative-free tears, plus an oral antihistamine and oral narcotic analgesic as needed.

"It is interesting that the highest mean pain score recorded was just 2.23 on a scale with a worst score of 10," Dr. Reilly said. "Those results indicate that the advanced surface ablation technique has really been helpful in minimizing pain."