Elsevier

Ophthalmology

Volume 102, Issue 12, December 1995, Pages 1918-1924
Ophthalmology

A Prospective, Randomized, Double-masked Trial to Evaluate the Role of Topical Anesthetics in Controlling Pain after Photorefractive Keratectomy*

https://doi.org/10.1016/S0161-6420(95)30775-0Get rights and content

Abstract

Purpose: To investigate the role of 1 % tetracaine in controlling pain after photorefractive keratectomy (PRK) and determining its effect, if any, on epithelial healing, refractive outcome, and visual performance.

Methods: In this study, 44 patients were randomized to receive either Gutt. 1% tetracaine or placebo after undergoing PRK. Drops were instilled at 30-minute intervals during waking hours for 24 hours postoperatively. In addition, all patients received two coproxamol (paracetamol + dextropropoxyphene) tablets every 6 hours for 2 days. Visual Analogue Pain Charts were used to record pain levels for 4 days after surgery. Serial digitized retro-illumination photography was used to assess rates of epithelial healing, and surface epithelial quality was monitored using topography. At fixed intervals over a 6-month period visual performance was assessed by measuring refractive outcome, best-corrected visual acuity, objective haze, halo, and glare.

Results: Patients in the tetracaine group had significantly less pain (P < 0.0001). Both groups demonstrated full epithelial closure within 72 hours. Similar numbers of patients in both groups at 1 week showed topographic irregularity that completely resolved by 1 month. No statistically significant difference was seen in any of the parameters monitoring visual performance.

Conclusions: Tetracaine in conjunction with coproxamol is effective in reducing pain after PRK without adversely affecting corneal wound healing or visual performance.

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      Pain is one of the most frequent complications after PRK.32 Bandage contact lenses33 and short time administration of topical anesthetics,34 topical opioids,35 and topical NSAIDs36 are widely used for the relief of postoperative pain. In addition, cold artificial tears and cooling of the eyes are recommended.37

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    *

    Presented in part at the ARVO Annual Meeting, Ft. Lauderdale, May 1995, and at the American Academy of Ophthalmology Annual Meeting, Atlanta, Oct/Nov 1995.

    **

    Dr. Corbett received the Williams fellowship for medical and scientific research of the University of London, London, England.

    ***

    Prof. Marshall is a consultant to Summit Technology.

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