A prospective, randomized, double-masked trial to evaluate the role of topical anesthetics in controlling pain after photorefractive keratectomy.
OBJECTIVE
To investigate the role of 1% tetracaine in controlling pain after photo-refractive 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.
Verma
S
S
Department of Ophthalmology, St. Thomas Hospital, London, UK.
Corbett
M C
MC
Marshall
J
J
D000082:Acetaminophen / Q000627:therapeutic use; D000287:Administration, Topical; D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage*; D003315:Cornea / Q000502:physiology / Q000601:surgery*; D011431:Dextropropoxyphene / Q000627:therapeutic use; D004311:Double-Blind Method; D004338:Drug Combinations; D004341:Drug Evaluation; D004848:Epithelium / Q000502:physiology; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009216:Myopia / Q000503:physiopathology / Q000601:surgery*; D009883:Ophthalmic Solutions; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D018903:Photorefractive Keratectomy / Q000009:adverse effects; D011446:Prospective Studies; D012029:Refraction, Ocular / Q000187:drug effects; D013748:Tetracaine / Q000008:administration & dosage*; D014792:Visual Acuity / Q000187:drug effects; D014945:Wound Healing / Q000187:drug effects
D000779:Anesthetics, Local; D004338:Drug Combinations; D009883:Ophthalmic Solutions; D013748:Tetracaine; D000082:Acetaminophen; C011800:acetaminophen, dextropropoxyphene, drug combination; D011431:Dextropropoxyphene