Effects of nonsteroidal ophthalmic drops on epithelial healing and pain in patients undergoing bilateral photorefractive keratectomy (PRK).
The present study, which was designed as a prospective, double-masked, randomized, controlled, single-site study, was conducted to compare the effects of 3 approved ophthalmic nonsteroidal anti-inflammatory drugs-nepafenac ophthalmic suspension 0.1% (Nevanac; Alcon Laboratories, Inc., Fort Worth, Tex), ketorolac tromethamine ophthalmic solution 0.4% (Acular LS; Allergan, Irvine, Calif), and bromfenac 0.09% (Xibromtrade mark; ISTA Pharmaceuticals, Irvine, Calif)-on corneal reepithelialization and postoperative pain control in patients undergoing photorefractive keratectomy. In addition to nonsteroidal anti-inflammatory drugs, each patient received an antibiotic-moxifloxacin hydrochloride ophthalmic solution 0.5% (nepafenac group) or gatifloxacin ophthalmic solution 0.3% (ketorolac and bromfenac groups). All treatments were administered 3 times daily beginning 1 d preoperatively and continuing for 1 wk postoperatively; prednisolone acetate 1.0% was administered concurrently 4 times daily. Bandage contact lenses were replaced at each postoperative visit for corneal staining and epithelial defect grading. Self-evaluation of pain relief was recorded on postoperative days 1 and 3 with the use of a visual analog scale. A total of 29 patients (58 eyes) were enrolled and underwent bilateral custom photorefractive keratectomy. Mean time to reepithelialization was 5.50+/-1.59 d for the nepafenac 0.1% group, 5.62+/-1.23 d for the ketorolac 0.4% group, and 7.25+/-2.53 d for the bromfenac 0.09% group. A significant difference was detected between nepafenac 0.1% and bromfenac 0.09% and between ketorolac 0.4% and bromfenac 0.09% (P<.05). Significant reductions in pain scores were observed with nepafenac 0.1% on day 1 (-1.13) and day 3 (-1.32), ketorolac 0.4% on day 3 (-0.88), and bromfenac 0.09% on day 3 (-0.83). No adverse events were reported. Eyes treated with nepafenac 0.1% or ketorolac 0.4% achieved complete reepithelialization significantly faster than those treated with bromfenac 0.09%. Daily contact lens removal and application of fluorescein may have delayed reepithelialization in the overall population; however, the effect would have been the same in all 3 groups. Pain relief with nepafenac 0.1% was achieved sooner than with ketorolac 0.4% or bromfenac 0.09%.
Durrie
Daniel S
DS
Durrie Vision, Overland Park, Kansas 66211, USA. ddurrie@durrievision.com
Kennard
Marla G
MG
Boghossian
Allen J
AJ
D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use*; D044482:Benzeneacetamides / Q000627:therapeutic use; D001577:Benzophenones / Q000627:therapeutic use; D001969:Bromobenzenes / Q000627:therapeutic use; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D019573:Epithelium, Corneal / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D020911:Ketorolac Tromethamine / Q000627:therapeutic use; D054018:Lasers, Excimer; D008297:Male; D008875:Middle Aged; D009883:Ophthalmic Solutions; D010149:Postoperative Pain / Q000188:drug therapy*; D010648:Phenylacetates / Q000627:therapeutic use; D018903:Photorefractive Keratectomy; D011239:Prednisolone / Q000031:analogs & derivatives / Q000627:therapeutic use; D011446:Prospective Studies; D014945:Wound Healing
D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D044482:Benzeneacetamides; D001577:Benzophenones; D001969:Bromobenzenes; D009883:Ophthalmic Solutions; D010648:Phenylacetates; C414203:nepafenac; D020911:Ketorolac Tromethamine; C053083:bromfenac; C009935:prednisolone acetate; D011239:Prednisolone