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Abdel-Radi M, Eldaly Z, Alattar S, Goda I. Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy. Ophthalmol Ther 2023; 12:3025-3038. [PMID: 37665497 PMCID: PMC10640409 DOI: 10.1007/s40123-023-00791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. METHODS In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. RESULTS Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8 h after surgery, and 1, 2, and 3 days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). CONCLUSION Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05733741.
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt.
| | - Zeiad Eldaly
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Sara Alattar
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Islam Goda
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
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Zheng Y, Zhai CB. Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review. Eye Contact Lens 2023; 49:449-458. [PMID: 37816246 PMCID: PMC10734785 DOI: 10.1097/icl.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 10/12/2023]
Abstract
ABSTRACT This study systematically reviewed the performance of bandage contact lenses (BCL) such as lotrafilcon A, lotrafilcon B, senofilcon A, balafilcon A, and comfilcon A as postoperative treatment in different ocular surgeries. A systematic search of English and Chinese databases (from inception to December 2021) was conducted for studies reporting the efficacy of BCLs after ocular surgeries. Postoperative symptoms, corneal healing, and visual outcomes were studied. Overall, 38 studies were identified. Bandage contact lens was applied as a postoperative aid in corneal refractive, cataract, and vitrectomy surgeries. Most studies were on photorefractive keratectomy. Reduced postoperative symptoms were observed within 4 hr to 3 days, whereas re-epithelization of the cornea and healing was complete within 3 to 7 days after ocular surgeries except for vitrectomy. In a vitrectomy, greater comfort and improved corneal epithelium were observed on the seventh day after surgery. An improvement in dry eye symptoms was observed at 7 days with considerable benefits observed after 1 month of cataract surgery. These findings indicate that BCLs are effective for improving postoperative symptoms and facilitation of early visual rehabilitation with a wear time of 8 hr to 7 days depending on the type of ocular surgery.
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Affiliation(s)
- Yan Zheng
- Beijing Tongren Eye Center (Y.Z.), Beijing KEY Laboratory of Ophthalmology and Visual Science; and Beijing Tongren Hospital (C.-B.Z.), Capital Medical University, Beijing, China
| | - Chang-Bin Zhai
- Beijing Tongren Eye Center (Y.Z.), Beijing KEY Laboratory of Ophthalmology and Visual Science; and Beijing Tongren Hospital (C.-B.Z.), Capital Medical University, Beijing, China
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Steigleman WA, Rose-Nussbaumer J, Al-Mohtaseb Z, Santhiago MR, Lin CC, Pantanelli SM, Kim SJ, Schallhorn JM. Management of Pain after Photorefractive Keratectomy: A Report by the American Academy of Ophthalmology. Ophthalmology 2023; 130:87-98. [PMID: 36207168 DOI: 10.1016/j.ophtha.2022.07.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To evaluate current best practices for postoperative photorefractive keratectomy (PRK) pain control. METHODS Literature searches in the PubMed database were last conducted in October 2021 and were restricted to publications in English. This search identified 219 citations, of which 84 were reviewed in full text for their relevance to the scope of this assessment. Fifty-one articles met the criteria for inclusion; 16 studies were rated level I, 33 studies were rated level II, and 2 studies were rated level III. RESULTS Systemic opioid and nonsteroidal anti-inflammatory drugs (NSAIDs); topical NSAIDs; postoperative cold patches; bandage soft contact lenses (BCLs), notably senofilcon A contact lenses; and topical anesthetics were demonstrated to offer significantly better pain control than comparison treatments. Some other commonly reported pain mitigation interventions such as systemic gabapentinoids, chilled intraoperative balanced salt solution (BSS) irrigation, cycloplegia, and specific surface ablation technique strategies offered limited improvement in pain control over control treatments. CONCLUSIONS Systemic NSAIDs and opioid medications, topical NSAIDs, cold patches, BCLs, and topical anesthetics have been shown to provide improved pain control over alternative strategies and allow PRK-associated pain to be more tolerable for patients.
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Affiliation(s)
| | | | | | | | | | - Seth M Pantanelli
- Department of Ophthalmology, Penn State College of Medicine, Hershey, Pennsylvania
| | - Stephen J Kim
- Department of Ophthalmology, Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Julie M Schallhorn
- Francis I. Proctor Foundation and Department of Ophthalmology, University of California, San Francisco, California
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Developing a Measure to Quantify Ocular Pain Postoperatively: The Adaptation of the Ocular Pain Assessment Survey. J Ophthalmol 2022; 2022:3116913. [PMID: 36276918 PMCID: PMC9586810 DOI: 10.1155/2022/3116913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 09/23/2022] [Indexed: 11/17/2022] Open
Abstract
Purpose Since quantification and communication of ocular pain is important for a healthier patient follow-up and postoperative guidance, reliable measures like the Ophthalmic Pain Assessment Survey (OPAS) are needed to assess the outcome and management of different operations. To address that need, we carried out the adaptation of OPAS into Turkish to reach different age groups and backgrounds, widening the use of OPAS on patients who underwent an ophthalmic operation. Methods We used back-translation method and achieved cultural adaptation through content validity scoring by 5 independent ophthalmologists. The survey is then administered three times: preoperatively, postoperatively within 24 hours, and finally a week later in the follow-up visit. Validity is measured in comparison to Visual Analog Scale using Spearman's correlation coefficient and reliability is measured using Cronbach's alpha. Factor analysis is performed by principal component analysis and rotation is performed using Varimax method when necessary. Results We reached a total of 132 patients with a mean age of 64.2 years. Most of them underwent phacoemulsification (n = 83), followed by PRK (n = 37). Overall, the T-OPAS demonstrated good reliability (mean C. alpha: 0.830) and its correlation with the VAS was especially high (S. coeff. >0.5) in the first three sections in all three surveys. Factor analysis yielded 5 subscales, allowing us to shape the final form of T-OPAS. Conclusion Through this adaptation of OPAS into a foreign language, we present a reliable and valid tool for postoperative pain quantification, allowing objective measurement of pain in different populations such as the elderly.
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Vázquez A, Martínez-Plaza E, Fernández I, Sobas EM, González-García MJ, Enríquez-de-Salamanca A, Ortega E, López-Miguel A, Calonge M. Phenotypic characterization of patients developing chronic dry eye and pain after refractive surgery: A cross-sectional study. Ocul Surf 2022; 26:63-74. [DOI: 10.1016/j.jtos.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 10/16/2022]
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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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Alkayid H, Asena L, Yüce A, Yavuz Çolak M, Altınörs DD. Comparison of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in keratoconus treatment. Ther Adv Ophthalmol 2021; 13:25158414211020147. [PMID: 34250443 PMCID: PMC8239960 DOI: 10.1177/25158414211020147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/06/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose To compare the severity and duration of ocular discomfort after three different epithelial debridement techniques for corneal collagen cross-linking in the treatment of keratoconus. Methods Fifty-five patients (65 eyes) known to have keratoconus were enrolled in this retrospective study. The eyes were divided into three groups based on the technique used for epithelial debridement for corneal collagen cross-linking procedure; excimer laser transepithelial phototherapeutic keratectomy was used in group 1 (18 eyes), alcohol-assisted epithelial removal was used in group 2 (27 eyes), and mechanical epithelial debridement was used in group 3 (20 eyes). Preoperative and postoperative (third month) best-corrected visual acuity (BCVA) using Snellen chart, objective refraction, and keratometry results were recorded. The results of the questionnaire obtained from the patient's medical records were reviewed regarding their subjective evaluation of postoperative symptoms including foreign body sensation, tearing, photophobia, and burning at the end of the first postoperative week. Paired-samples t test was used to compare preoperative and postoperative clinical findings. One-way analysis of variance (ANOVA) was used to analyze the differences between three independent groups. Results BCVA improved from 0.51 ± 0.27 to 0.58 ± 0.21 (p = 0.05). Objective mean spherical and cylindrical refraction decreased from -5.08 ± 2.78D to -4.46 ± 2.91D (p = 0.22) and from -3.45 ± 2.73D to -3.03 ± 1.97D (p = 0.25). Mean maximum keratometry reading (K max) decreased from 57.63 ± 4.73D to 56.13 ± 4.47D (p = 0.001). The mean score for foreign body sensation was the highest in group 3 (4.50 ± 0.53) and the lowest in group 1 (2.10 ± 1.85) (p = 0.01). The mean scores for tearing, photophobia, and burning sensation were comparable in three groups (p = 0.84, p = 0.13, and p = 0.61, respectively). The duration of photophobia was the shortest in group 1 (1.50 ± 2.37 days), followed by group 3 (2.00 ± 1.31 days) and group 2 (4.00 ± 1.83 days) (p = 0.04). Conclusions The severity and duration of adverse subjective symptoms during the first postoperative week after corneal collagen cross-linking appear to be milder with epithelial debridement using excimer laser transepithelial technique compared with -assisted debridement and mechanical debridement.
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Affiliation(s)
- Hosamadden Alkayid
- Jordanian Royal Medical Services, King Hussein Medical Center, Amman, Jordan
| | - Leyla Asena
- Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Aslihan Yüce
- Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Meriç Yavuz Çolak
- Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
| | - Dilek Dursun Altınörs
- Department of Ophthalmology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Kontadakis GA, Chronopoulou KG, Tsopouridou R, Tabibian D, Kymionis GD. Nepafenac Ophthalmic Suspension 0.3% for the Management of Ocular Pain After Photorefractive Keratectomy. J Refract Surg 2018. [PMID: 29522226 DOI: 10.3928/1081597x-20180123-03] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To investigate the effect of nepafenac 0.3% in a once daily dosage regarding pain and healing after photorefractive keratectomy (PRK). METHODS This was a prospective, comparative, contralateral randomized study of 35 patients undergoing PRK for the correction of low to moderate myopia and myopic astigmatism. After randomization, patients received nepafenac 0.3% ophthalmic suspension once daily in one eye (nepafenac 0.3% group) and nepafenac 0.1% ophthalmic suspension three times a day in the other eye (nepafenac 0.1% group) until the second postoperative day. Pain was evaluated every 2 hours on the day of the operation and then once daily using a scale ranging from 0 to 4. Patients were then examined at 2 weeks and 1, 3, 6, and 12 postoperative months. Visual acuity and subepithelial haze were also assessed. RESULTS No differences were detected between groups in pain scores, subepithelial haze scores, or visual acuity. Refractive predictability was also similar. CONCLUSIONS Nepafenac 0.3% ophthalmic suspension in a daily regimen after PRK seems to be an effective treatment for pain and ocular discomfort with effects similar to the 0.1% suspension. [J Refract Surg. 2018;34(3):171-176.].
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Codeine Plus Acetaminophen for Pain After Photorefractive Keratectomy: A Randomized, Double-Blind, Placebo-Controlled Add-On Trial. Cornea 2017; 36:1206-1212. [DOI: 10.1097/ico.0000000000001328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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Sobas EM, Videla S, Vázquez A, Fernández I, Maldonado MJ, Pastor JC. Pain perception description after advanced surface ablation. Clin Ophthalmol 2017; 11:647-655. [PMID: 28435216 PMCID: PMC5391165 DOI: 10.2147/opth.s134542] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose The objective of this study was to characterize the evolution of ocular pain after advanced surface ablation (ASA) to improve strategies in postoperative pain management. Methods This was a multicenter, prospective, descriptive, cohort study. The inclusion criteria were healthy individuals ≥18 years old receiving bilateral alcohol-assisted surface ablation with epithelial removal. Pain intensity was evaluated with the visual analog scale (VAS) and the numeric pain rating scale before and after surgery. Comorbidities (photophobia, burning, tearing, and foreign body sensation) and Hospital Anxiety and Depression (HAD) questionnaire were evaluated before and at 6 hours after surgery. Postoperative treatments included cold patch, topical cold antibiotics, topical steroids, and benzodiazepines. Results Thirty-two consecutive patients having similar profiles of postoperative pain evolution were included. At 0.5 hour after ASA, the pain score by VAS was 37±20 mm, and the maximum pain, 61±31 mm, occurred at 24 hours. Afterward, it decreased progressively until 72 hours after surgery (19±20 mm). Most patients (81%) scored >60 mm, and 44% required rescue medication. Among the comorbidities, all patients had photophobia and 84% had burning sensation. At 6 hours, the HAD score was 5.4±3.9, within the range of values considered as normal. Conclusion Postoperative acute ocular pain after ASA showed a characteristic evolution over time. Recognition of the pattern could be important for improving the acceptance of ASA and for improving strategies in pain management in the postoperative period.
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Affiliation(s)
- Eva M Sobas
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Facultad de Enfermería, Universidad de Valladolid, Valladolid Spain
| | - Sebastián Videla
- Laboratorios Dr. Esteve S.A., Barcelona, Spain.,Department of Experimental and Health Sciences, Facultad de Ciencias de la Salud y de la Vida, Universidad Pompeu Fabra, Barcelona, Spain
| | - Amanda Vázquez
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - Itziar Fernández
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Networking Research Center on Bioengineering, Biomaterials and Nanomedicine (CIBER-BBN), Valladolid, Spain
| | - Miguel J Maldonado
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain
| | - José-Carlos Pastor
- Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Valladolid, Spain.,Department of Ophthalmology, Hospital Clínico Universitario, Valladolid, Spain.,Department of Surgery, Ophthalmology, Otorhinolaryngology and Physiotherapy, Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
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Eclectic Ocular Comorbidities and Systemic Diseases with Eye Involvement: A Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6215745. [PMID: 27051666 PMCID: PMC4808667 DOI: 10.1155/2016/6215745] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Revised: 01/01/2016] [Accepted: 02/01/2016] [Indexed: 02/07/2023]
Abstract
Coexistence of several ocular diseases is more frequent than suspected. In spite of the refractive errors, one or more of the following can be detected simultaneously: glaucoma, cataracts, uveitis, age-related macular degeneration, and dry eyes. In addition, as people age, ocular comorbidities are much more usually seen. Specific diseases are openly acknowledged to affect the eyes and vision, such as diabetes mellitus, hypertension blood pressure, arthritis, hyperthyroidism, neurodegenerative disorders, hematologic malignancies, and/or systemic infections. Recent advances in early diagnosis and therapy of the ophthalmic pathologies have reinforced patient options to prevent visual impairment and blindness. Because of this, it is essential not to overlook sight-threatening conditions such as the ocular comorbidities and/or the eye involvement in the context of systemic disorders. Moreover, the important role of the multidisciplinary cooperation to improve and sustain management of patients affected with eclectic ocular comorbidities and/or systemic disorders with eye repercussion is specifically addressed. This review intends to shed light on these topics to help in making opportune diagnosis and appropriately managing the affected patients.
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