Post Photorefractive Keratectomy Pain is Uncommon, and Manageable

Pain management following ophthalmic procedures is a priority concern for clinicians, and a recent study suggests that patient education and counseling may be better predictors of pain following photorefractive keratectomy (PRK) than the ablation depth, sex of patient, time of year, or surgeon status; for example, resident or staff ophthalmologist.

At the Joint Warfighter Refractive Surgery Center (JWRSC) in San Antonio, 231 patients who received PRK to treat myopia were evaluated for pain on postoperative days 1 and 7. For pain management, patients were given 20 pills of 1 of 3 standard post-PRK oral analgesics, and an unopened bottle of topical tetracaine hydrochloride 0.5%. They were instructed to use the tetracaine only if pain was severe and prevented rest.

Topical tetracaine use was the single variable associated with increased pain score, and patients who used these drops also took more of the oral analgesics.

“No significant difference for the number of pills taken was found (based on factors such as ablation depth, gender, etc.), with the exception of those who used topical tetracaine,” the researchers wrote. They added that patients who used topical tetracaine took a higher amount of oral pain medication (9.44 ± 6.01) compared with those who did not (7.02 ± 4.71) (P =.022).

Investigators expected that patients who experienced greater pain would use the prescribed tetracaine, but were encouraged that no cases of epithelial defects or delayed epithelial healing occurred, suggesting this medication was used only as directed and when needed.

All patients at the center underwent counseling before choosing and undergoing PRK or laser assisted in situ keratomileusis refractive surgery. Since no statistically significant association was found between pain score and surgeon status; that is, resident or staff surgeon, “this further supports that adequate training of the surgeon along with a standardized preoperative counseling of the patient is a better predictor of postoperative pain outcomes,” according to the study’s authors.

An interesting supplemental result was found for the patients who did use tetracaine drops. Pain between eyes was markedly different on postoperative day 7 — with greater pain in the left eye than the right.

Patients in this study took a mean number of 7.43 (± 5.02) oral pain pills in the first postoperative week. Researchers affirmed that identifying an average number of oral analgesic tablets typically needed for pain also contributes knowledge to effective and safe prescribing routines.

“Future studies involving a comparison across the different opioid pain medications and their effects on post-PRK pain scores between sex may prove useful in determining which oral opiate is most efficacious and differences in opioid pain medication use/misuse,” researchers added.

Reference

Palochak C, Satamaria J, Justin G, et al. Assessment of factors associated with postoperative pain after photorefractive keratectomy. Cornea. 2020;39(10): 1215-1220. doi: 10.1097/ICO.0000000000002402.