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Lafreniere JD, Szczesniak AM, Courtney E, Kelly MEM, Faktorovich EG. Topical analgesics for acute corneal pain: current options and emerging therapeutics. J Cataract Refract Surg 2023; 49:1160-1167. [PMID: 37232414 DOI: 10.1097/j.jcrs.0000000000001225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 05/18/2023] [Indexed: 05/27/2023]
Abstract
Acute corneal pain is a common complaint that causes significant distress to patients and continues to challenge therapeutic avenues for pain management. Current topical treatment options have marked limitations in terms of both efficacy and safety, thus often prompting the adjunctive use of systemic analgesics, including opioids. In general, there have not been extensive advancements in pharmacologic options for the management of corneal pain over the past several decades. Despite this, multiple promising therapeutic avenues exist which hold the potential to transform the ocular pain landscape, including druggable targets within the endocannabinoid system. This review will summarize the current evidence base for topical nonsteroidal anti-inflammatory drugs, anticholinergic agents, and anesthetics before focusing on several potential avenues in the setting of acute corneal pain management, including autologous tear serum, topical opioids and endocannabinoid system modulators.
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Affiliation(s)
- J Daniel Lafreniere
- From the Department of Pharmacology, Dalhousie University, Halifax, Nova Scotia, Canada (Lafreniere, Szczesniak, Courtney, Kelly); Department of Ophthalmology & Visual Sciences, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Halifax, Nova Scotia, Canada (Kelly); Pacific Vision Institute, San Francisco, California (Faktorovich)
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Thompson V, Moshirfar M, Clinch T, Scoper S, Linn SH, McIntosh A, Li Y, Eaton M, Ferriere M, Stasi K. Topical Ocular TRPV1 Antagonist SAF312 (Libvatrep) for Postoperative Pain After Photorefractive Keratectomy. Transl Vis Sci Technol 2023; 12:7. [PMID: 36917119 PMCID: PMC10020951 DOI: 10.1167/tvst.12.3.7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023] Open
Abstract
Purpose Evaluation of safety and efficacy of topical ocular SAF312 (Libvatrep) in post-photorefractive keratectomy (PRK) pain. Methods In this placebo (vehicle)-controlled, participant- and investigator-masked study, 40 participants were randomized (1:1) to two treatment sequences in a bilateral PRK crossover design (SAF312 2.5% followed by vehicle [or vice versa], one eye drop, four times daily for 72 hours after PRK). Primary endpoints were visual analog scale (VAS) pain scores at 6 hours after first drop of study drug and average VAS scores over 0 to 12 hours postoperatively. Secondary endpoints included postoperative oral rescue medication (ORM) use and adverse events (AEs). Results All 40 participants completed the study. Both primary endpoints were met; mean difference in VAS pain scores between SAF312- and vehicle-treated eyes was -11.13 (P = 0.005, -25%) at 6 hours postoperatively and -8.56 (P = 0.017, -22%) over 0 to 12 hours. Mean VAS pain scores with SAF312 were consistently lower than with vehicle from 1 hour postoperatively up to 30 hours (P ≤ 0.10 observed in 8/11 time points). Less ORM was taken with SAF312 up to 0 to 72 hours postoperatively, with a trend of fewer participants taking ORM at 0 to 24 hours postoperatively with SAF312 versus vehicle. No serious AEs were reported. All ocular AEs were mild and transient, and none were drug related. SAF312-treated eyes showed no delay in wound healing and had a lower grade 4 conjunctival hyperemia 24 hours postoperatively versus vehicle-treated eyes. Conclusions SAF312 was well tolerated and effective in reducing ocular pain post-PRK. Translational Relevance Topical SAF312 presents a new therapeutic option for patients undergoing PRK.
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Affiliation(s)
- Vance Thompson
- Vance Thompson Vision, Sioux Falls, SD, USA.,University of South Dakota, Sanford School of Medicine, Sioux Falls, SD, USA
| | - Majid Moshirfar
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | | | - Steven H Linn
- Hoopes, Durrie, Rivera Research, Hoopes Vision, Draper, UT, USA
| | | | - Yifang Li
- Novartis Pharmaceuticals Corp., East Hanover, NJ, USA
| | - Matt Eaton
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
| | | | - Kalliopi Stasi
- Novartis Institute of Biomedical Research, Cambridge, MA, USA
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Chen W, Liu J, Yang Y, Ai Y, Yang Y. Ketorolac Administration After Colorectal Surgery Increases Anastomotic Leak Rate: A Meta-Analysis and Systematic Review. Front Surg 2022; 9:652806. [PMID: 35223972 PMCID: PMC8863852 DOI: 10.3389/fsurg.2022.652806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
Objective This meta-analysis aimed to evaluate whether ketorolac administration is associated with an increased anastomotic leak rate after colorectal surgery. Methods The literature was searched using the Web of Science, Embase, and PubMed databases, and the search ended on May 31, 2020. The Newcastle–Ottawa Scale was used to assess methodological quality. Statistical heterogeneity was assessed using the Chi-square Q test and I2 statistics. Subgroup analysis was performed, and Egger's test was used to assess publication bias. Results This meta-analysis included seven studies with 400,822 patients. Our results demonstrated that ketorolac administration after surgery increases the risk of anastomotic leak [OR = 1.41, 95% CI: 0.81–2.49, Z = 1.21, P = 0.23]. Low heterogeneity was observed across these studies (I2 = 0%, P = 0.51). The results of subgroup analysis showed that the use of ketorolac in case–control and retrospective cohort studies significantly increased the risk of anastomotic leak (P < 0.05). Furthermore, the subgroup analysis revealed that ketorolac use increased anastomotic leak rate in patients in the United States and Canada, and ketorolac plus morphine use did not increase anastomotic leak rate in Taiwanese patients (P < 0.05). No significant publication bias was observed (P = 0.126). Moreover, the analysis of risk factors related to anastomotic leak rate indicated that the total use of ketorolac did not increase the risk of anastomotic leak similar to the control group (P > 0.05). Conclusion The meta-analysis indicates that the use of ketorolac increases the risk of anastomotic leak after colorectal surgery. Systematic Review Registration PROSPERO, identifier CRD42020195724.
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Affiliation(s)
- Wen Chen
- Department of Anus and Intestine Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
- *Correspondence: Wen Chen
| | - Jing Liu
- Department of Endocrinology, Hebei General Hospital, Shijiazhuang, China
| | - Yongqiang Yang
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
| | - Yanhong Ai
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
| | - Yueting Yang
- Department of General Surgery, Shijiazhuang People Hospital, Shijiazhuang, China
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Mohammadpour M, Rezaei F, Heirani M, Khorrami-Nejad M. Comparison of Postoperative Symptoms of Alcohol-Assisted Versus Mechanical Epithelial Removal in Photorefractive Keratectomy: A Contralateral Double Blind Clinical Trial. Eye Contact Lens 2021; 47:655-659. [PMID: 34393178 DOI: 10.1097/icl.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare the short-term complaints of postoperative pain, and other ocular discomfort symptoms in patients who underwent photorefractive keratectomy (PRK) with alcohol-assisted epithelial removal in one eye versus mechanical debridement in the other eye. METHOD A prospective, interventional, contralateral double blind clinical trial was performed on 164 eyes of 82 candidates of PRK surgery. The patients were divided into two groups. The first group was alcohol-assisted PRK group in which the epithelial removal was performed on their right eye. The second group was mechanical PRK group in which epithelial removal was performed on their left eye. A numerical rating scale was given to the patients to describe the severity of postoperative pain on the first day following PRK. Postoperative discomfort symptoms including the complaints of light sensitivity, tearing, blurring, and foreign body sensation was also provided by the survey form. RESULTS One day following PRK, the mean pain score of the alcohol-assisted PRK group and the mechanical PRK group was 3.4±3.1 and 4.1±3.3, respectively (P=0.019). The highest scores recorded for alcohol-assisted and mechanical treated groups were burning (5.22) and light sensitivity (5.46), respectively. Sixty-eight (82.9%) of all patients experienced postoperative pain, and in 52 (76.5%) of them, the time of pain onset was less than 2 hrs. CONCLUSION We found less pain and discomfort using alcohol-assisted technique compared with mechanical epithelial removal that was provided by a detailed pain and ocular discomfort symptoms assessment one day following PRK surgery.
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Affiliation(s)
- Mehrdad Mohammadpour
- Translational Ophthalmology Research Center (M.M., F.R., M.H., M.K.-N.), Farabi Eye Hospital, Tehran University of Medical Sciences, Tehran, Iran; and School of Rehabilitation (M.K.-N.), Tehran University of Medical Sciences, Tehran, Iran
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Mohammadpour M, Heirani M, Khorrami-Nejad M, Ambrósio R. Update on Pain Management After Advanced Surface Ablation. J Refract Surg 2021; 37:782-790. [PMID: 34756143 DOI: 10.3928/1081597x-20210809-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To provide an update for postoperative pain control strategies to help ophthalmic surgeons establish a more effective management plan for patients who underwent advanced surface ablation surgeries. METHODS Google Scholar, Scopus, ScienceDirect, and PubMed were the main resources used to search the medical literature. RESULTS The postoperative cornea's healing process is accompanied by intense pain as the chief complaint in the first days after the operation. Several strategies were developed to relieve postoperative pain after surface ablation procedures. These strategies included different preoperative, intraoperative, and postoperative methods. Considering the preoperative demographic and emotional factors, underlying dry eye, alternative epithelial removal techniques, bandage contact lenses, and topical or oral therapeutic agents are some examples of postoperative pain treatments after surface ablation procedures. CONCLUSIONS The current review revealed that despite the development of numerous protocols to relieve postoperative pain following surface ablations, the best approach could be a combination of different strategies. In practice, no validated and standardized strategy is available for total elimination of postoperative pain following advanced surface ablation surgeries. [J Refract Surg. 2021;37(11):782-790.].
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Socea SD, Abualhasan H, Magen O, Zayit-Soudry S, Blumenthal EZ, Duvdevan N, Mimouni M. Preoperative Anxiety Levels and Pain during Cataract Surgery. Curr Eye Res 2019; 45:471-476. [DOI: 10.1080/02713683.2019.1666996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Sergiu D. Socea
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Hamza Abualhasan
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Or Magen
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Shiri Zayit-Soudry
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Eytan Z. Blumenthal
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
| | - Nitsan Duvdevan
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
| | - Michael Mimouni
- Department of Ophthalmology, Rambam Health Care Campus, Haifa, Israel
- Ruth & Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Schechter BA. Use of topical bromfenac for treating ocular pain and inflammation beyond cataract surgery: a review of published studies. Clin Ophthalmol 2019; 13:1439-1460. [PMID: 31534309 PMCID: PMC6682171 DOI: 10.2147/opth.s208700] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/27/2019] [Indexed: 01/20/2023] Open
Abstract
Topical ophthalmic nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used to treat postoperative inflammation and pain following cataract surgery and for treatment and prophylaxis of pseudophakic cystoid macular edema (CME). Bromfenac is a brominated NSAID with strong in vitro anti-inflammatory potency. Like other ophthalmic NSAIDs, bromfenac is often used outside of the cataract surgery setting. This paper provides an overview of bromfenac’s preclinical ocular pharmacology and pharmacokinetics, followed by a review of 23 published clinical studies in which various marketed bromfenac formulations were used for conditions other than cataract surgery or pseudophakic CME. These include: post-refractive eye surgery; macular edema associated with diabetes, uveitis, or retinal vein occlusion; inflammation associated with age-related macular degeneration; pain related to intravitreal injections; and other ocular anterior segment and surface disorders with an inflammatory component. The published evidence reviewed supports the safety and effectiveness of bromfenac in these additional ophthalmic indications. Bromfenac was well tolerated when given alone or in combination with intravitreal anti-vascular endothelial growth factor agents, topical corticosteroids, or topical mast-cell stabilizers. The most common adverse event reported was ocular irritation. No serious adverse events (ie, corneal epithelial disorders) were reported, although the majority of studies did not systematically evaluate potential side effects. Corneal complications, such as melts reported with diclofenac and ketorolac, were not observed with bromfenac in the studies. In summary, published study data support the clinical utility of bromfenac in various ocular disorders beyond post-cataract surgery. Additional studies are warranted to further define the potential role of bromfenac ophthalmic solution in clinical practice.
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Affiliation(s)
- Barry A Schechter
- Cornea and Cataract Service, Florida Eye Microsurgical Institute, Boynton Beach, FL, USA
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Bandage contact lens use after photorefractive keratectomy. J Cataract Refract Surg 2019; 45:1183-1190. [DOI: 10.1016/j.jcrs.2019.02.045] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 02/04/2019] [Accepted: 02/28/2019] [Indexed: 01/19/2023]
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