Ketorolac Tromethamine for Control of Intraoperative and Size：220.00 K | View：1 | Page：13Ketorolac Tromethamine 0.4% for Control of Intraoperative and Postoperative LASIK Pain Paul J. Dougherty MD Dougherty Laser Vision Institute, Camarillo, CA, USA Jules Stein Eye Institute, Los Angeles, CA, USA Financial Disclosure: Study supported by an unrestricted grant from Allergan,...
Ketorolac Tromethamine 0.4% for Control of Intraoperative and Postoperative LASIK Pain Paul J. Dougherty MD Dougherty Laser Vision Institute, Camarillo, CA, USA Jules Stein Eye Institute, Los Angeles, CA, USA Financial Disclosure: Study supported by an unrestricted grant from Allergan, Inc. BackgroundPostoperative LASIK pain occurs within the first 3 days and is due to surgical manipulation that causes corneal inflammation, disruption of the corneal epithelial layer, as well as dryness of the surface epithelium. Topical nonsteroidal anti-inflammatory drugs (NSAIDs) such as ketorolac tromethamine have been used to mitigate postsurgical pain.Background/ObjectiveKetorolac tromethamine 0.4% (ACULAR LS®; Allergan, Inc.; Irvine, CA) is an NSAID that is indicated for the reduction of pain, burning, and stinging following corneal refractive surgery. Ketorolac tromethamine 0.4% affects the arachidonic acid cascade at peripheral sites by inhibiting cyclooxygenase (COX) activity. The partial inhibition of prostaglandin synthesis and release reduces the inflammatory response due to surgery. Additionally, ketorolac tromethamine 0.4% may reduce corneal sensation, which may further reduce intraoperative pain. This study assessed the effect of ketorolac tromethamine 0.4% drops in controlling LASIK pain. Arachidonic Acid CascadeAdapted from: Polansky and Weinreb. In: Pharmacology of the Eye. 1984.Goal: Block Multiple Targets for Prostaglandin SynthesisLeukotrienesMethodsProspective, randomized, double-blind, controlled study Sixty eyes of 30 patients who underwent myopic LASIK surgery One surgeon using a standardized LASIK technique with the BD K-4000® mechanical microkeratome (Becton, Dickinson and Co.; Franklin Lakes, NJ) and a VISX® Star S4™ (AMO USA,Inc.; Santa Ana, CA) or NIDEK EC-5000 excimer laser (NIDEK® Co. Ltd.; Gamagori, Japan) Randomization table generated by a biostatisticianMethodsPatients were randomly assigned to instill 1 drop from one of 2 unmarked bottles containing either ketorolac tromethamine 0.4% in one eye and REFRESH TEARS® in the fellow eye 4 times a day beginning 48 hours prior to LASIK, just prior to the keratome pass, and at the conclusion of surgery Patients, immediately following flap creation, were to score pain on a scale of 1 (no pain) to 6 (extreme pain) and again 4 to 6 hours postoperativelyMethods Inclusion criteria 21 years old or older Candidate for simultaneous, bilateral, LASIK Exclusion criteria Preexisting corneal disease Ocular inflammation Glaucoma Used topical eye medications 3 weeks prior to LASIK Noncompliance with the study protocol Allergy to oral diazepamMethodsBiomicroscopy at 1 day postoperatively to check for flap slips and microstraie A t test was used to analyze pain scores following surgery A P value <.05 was considered statistically significant Rating Scale Severity Rating Description 0 No symptoms 1 Barely noticeable 2 Noticeable, but not bothersome 3 Bothersome 4 Definitely annoying 5 Painful, very uncomfortable 6 Extremely painfulResultsThe ketorolac group experienced statistically significant lower levels of pain postoperatively (P = .002) P = .085 for comparison of intraoperative pain score No flap slips or microstraie postoperativelyDiscussion Most patients experience discomfort during and after LASIK due to a 10-fold increase in intraocular pressure during flap creation and the disruption of the epithelium along the flap edge. Reduced intraoperative pain can lead to greater patient cooperation during surgery, reducing surgery time and the risk of complications inherent with longer surgical times. Postoperative discomfort can result in involuntary rubbing and flap dislocation. ConclusionIn conclusion, the use of preoperative and intraoperative ketorolac tromethamine 0.4% significantly reduced postoperative pain and decreased intraoperative pain associated with LASIK. Reduction of pain may allow for greater patient compliance and reduce the risk of complications intraoperatively and postoperatively.Selected ReferencesLoarie TM, Applegate D, Kuenne CB, Choi LJ, Horowitz DP. Use of market segmentation to identify untapped consumer needs in vision correction surgery for future growth. J Refract Surg. 2003;19:566-576. Price MO, Price FW. Efficacy of topical ketorolac tromethamine 0.4% for control of pain or discomfort associated with cataract surgery. Curr Med Res Opin. 2004;20:2015-2019. Price FW Jr, Price MO, Zeh W, Dobbins K. Pain reduction after laser in situ keratomileusis with ketorolac tromethamine opthalmic solution 0.5%: a randomized, double-masked, placebo-controlled trial. J Refract Surg. 2002; 18:140-144. Sun R, Gimbel HV. Effects of topical ketorolac and diclofenac on normal corneal sensation. J Refract Surg. 1997;13:158-161. Sachs HG, Lohmann CP, Op de Laak JP. Intraocular pressure in sections with 2 microkeratomes in vitro [in German]. Ophthalmologe. 1997;94:707-709.