A prospective randomized trial of topical soluble 0.1% indomethacin versus 0.1% diclofenac versus placebo for the control of pain following excimer laser photorefractive keratectomy.
OBJECTIVE
To compare the safety and efficacy of topical nonsteroidal antiinflammatory drugs (NSAIDs) for the control of pain after excimer laser photorefractive keratectomy (PRK).


METHODS
One hundred twenty informed patients were enrolled in a double-masked, randomized, comparative study and assigned to either 0.1% indomethacin, 0.1% diclofenac, or placebo treatment. Subjective postoperative pain, symptoms, re-epithelialization rate, and systemic medications were monitored for 2 days following photoablation.


RESULTS
Compared with the placebo, 0.1% indomethacin solution significantly reduced pain on the day of surgery (D0) (P < .05), whereas 0.1% diclofenac did not reach a significant level (P = .46). At D0, analgesic intake by the oral route was significantly greater in the placebo group (P < .05). Severe photophobia was significantly less frequent in the group treated with 0.1% indomethacin (P < .05). Corneal wound healing was significantly delayed in the patients treated with 0.1% diclofenac at D2 as compared with other groups (P = .04).


CONCLUSIONS
Topical 0.1% indomethacin solution helps control the pain induced by excimer laser photoablation of the cornea without any detrimental effect to the corneal epithelial wound healing.
Assouline
M
M
Department of Ophthalmology, Hôtel-Dieu de Paris, INSERM U86, University of Paris VI, Medical School, France.
Renard
G
G
Arne
J L
JL
David
T
T
Lasmolles
C
C
Malecaze
F
F
Pouliquen
Y J
YJ
D000287:Administration, Topical; D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage* / Q000627:therapeutic use; D003315:Cornea / Q000601:surgery; D004008:Diclofenac / Q000008:administration & dosage* / Q000627:therapeutic use; D004311:Double-Blind Method; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007213:Indomethacin / Q000008:administration & dosage* / Q000627:therapeutic use; D054018:Lasers, Excimer; D008297:Male; D009216:Myopia / Q000601:surgery; D009883:Ophthalmic Solutions; D017288:Pain Threshold / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D018903:Photorefractive Keratectomy / Q000009:adverse effects*; D011446:Prospective Studies; D012449:Safety; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects
D000894:Anti-Inflammatory Agents, Non-Steroidal; D009883:Ophthalmic Solutions; D004008:Diclofenac; D007213:Indomethacin