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Purpose: To define the factors that affect patient's self-assessed postoperative pain after photorefractive keratectomy (PRK)., Methods: Patients who underwent PRK in 2016 were evaluated. Anonymized data collected included patient gender, age, and season at the time of surgery, ablation depth, surgeon status (attending vs. resident), topical tetracaine use, and subjective pain scores at postoperative days (PODs) 1 and 7. Average pain scores and amount of pain medication taken were analyzed for each of the previously mentioned variables., Results: Overall, 231 patients who underwent PRK were analyzed. The mean pain score and SD were 0.78 ± 1.87 on POD 1 and 0.03 ± 0.37 by POD 7. Patients who used topical tetracaine reported significantly higher pain on POD 1 and 7 compared with patients who did not use tetracaine (P < 0.001 and P = 0.038, respectively). No significant differences in pain scores were seen based on surgeon status, ablation depth, gender, and season. 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 = 0.022)., Conclusions: Postoperative pain was significantly elevated in patients who used tetracaine on POD 1 and POD 7. These patients were also more likely to take oral pain medication than those who did not use topical tetracaine. Surgeon status, season, gender, and ablation depth showed no significant differences in subjective pain scores. Oral pain medication should be evaluated to assess efficacy and safety in inhibiting ocular pain after PRK.

The use of a bandage contact lens (BCL) immediately after photorefractive keratectomy (PRK) results in less pain. This review analyzed which BCL is most effective in decreasing pain immediately after PRK and evaluated the reepithelialization process in the treated zone. Two databases, PubMed and Medline, were checked for articles published from January 2005 to May 2018. The keywords were photorefractive keratectomy, PRK, contact lens, and bandage contact lens. The review comprised 13 studies; these studies enrolled 842 patients who had PRK. All studies compared the early postoperative results for two types of BCL material (senofilcon A and lotrafilcon A). Of the materials, the pain scores were lowest with a senofilcon A. The size of the defect in the epithelialized area 1 day after surgery decreased fastest with lotrafilcon A., (Copyright © 2019 ASCRS and ESCRS. Published by Elsevier Inc. All rights reserved.)

Purpose: To compare the postoperative pain and epithelial healing time in conventional and subepithelial accelerated corneal collagen cross-linking (CXL) for progressive keratoconus., Methods: The medical records of 27 consecutive patients who underwent accelerated CXL for progressive keratoconus were retrospectively reviewed. Patients were divided into two groups: the conventional (n = 16) and the subepithelial accelerated CXL group (n = 11). Corneal epithelial layers with a diameter of 8.5 mm in central corneas were removed in the conventional group, while epithelial flaps with the same diameter were prepared in the subepithelial group before accelerated CXL procedures. Postoperative pain and epithelial healing time were evaluated within 1 week., Results: No complications developed in the subepithelial group, whereas peripheral corneal sterile infiltrate was observed in three eyes in the conventional group, which disappeared after treated with steroids for a week. The pain of patients in subepithelial group was significantly slighter than those in conventional group, with a significant difference in pain scoring 0, 1, 2 and 3 days postoperatively (P = 0.002, P = 0.001, P = 0.001, P = 0.001, respectively). Different from the fact that patients in subepithelial group had epithelium after operation, the healing time for epithelium in conventional group was 3-6 days, with an average of 4.64 ± 0.59 days., Conclusions: Subepithelial accelerated CXL significantly improved postoperative pain as well as reduced the epithelial healing time for the treatment of keratoconus.

Technologic improvements in cataract surgery have not only improved visual outcomes, but also have minimized intraoperative and postoperative pain. We review the mechanisms, risk factors, and management of intraoperative and postoperative pain. Summaries of less common sources of physiologic pain have been included to reinforce recognition of when pain represents an expected physiologic reaction to surgery as opposed to signaling a more serious complication. We also discuss various current and emerging anesthetic and analgesic modalities., (Published by Elsevier Inc.)

Purpose: To evaluate the efficacy and safety of phenylephrine 1.0%-ketorolac 0.3% (Omidria) for maintenance of mydriasis during, and reduction of ocular pain after, cataract surgery., Setting: Twenty centers in the United States and the Netherlands., Design: Prospective randomized clinical trials., Methods: Patients having cataract surgery or refractive lens exchange were enrolled in 2 clinical trials. Phenylephrine 1.0%-ketorolac 0.3% or placebo was added to irrigation solution and administered intracamerally during the procedure. Integrated analyses of primary and secondary endpoints were conducted., Results: The clinical trials comprised 808 patients (403 treatment and 405 placebo). Phenylephrine 1.0%-ketorolac 0.3% was superior to placebo for the maintenance of mydriasis during, and reduction of ocular pain following, cataract surgery. The mean area under the curve (AUC) change from baseline in pupil diameter was 0.08 mm for treatment compared with -0.50 mm for placebo (P < .0001). The mean AUC of ocular pain visual analog scale scores within 12 hours postoperatively was 4.16 mm for the treatment group and 9.06 mm for the placebo group (P < .001). Results of all secondary efficacy analyses demonstrated a significant treatment effect associated with phenylephrine 1.0%-ketorolac 0.3%. Treatment-emergent adverse events were as expected for a population having cataract surgery; no clinically significant differences in safety measures were observed between treatment groups., Conclusion: In this integrated analysis, phenylephrine 1.0%-ketorolac 0.3% administered intracamerally with irrigation solution during cataract surgery was safe and effective for maintaining mydriasis during the procedure and reducing postoperative ocular pain., Financial Disclosure: Dr. Schaaf is an employee and holds an equity interest in Omeros Corporation. Drs. Hovanesian, Sheppard, Trattler, Gayton, and Ng are consultants to Omeros Corporation. No other author has a financial or proprietary interest in any material or method mentioned., (Copyright © 2015 The Authors. Published by Elsevier Inc. All rights reserved.)

Purpose: To examine the effect of a 1-time dose of pregabalin (Lyrica) on the perception of pain and analgesic consumption after oculofacial plastic surgery., Methods: In this prospective, randomized, double-blind, placebo-controlled trial, patients presenting to the oculofacial plastic surgery service at University of Colorado Eye Center for functional eyelid surgery and who met the study criteria were consecutively enrolled between October 2011 and September 2012. Subjects were randomized to either placebo or 150 mg pregabalin administered 15 minutes to an hour prior to the procedure. The procedure was then performed under the usual standard of care. Postoperatively, study subjects recorded pain scores on visual analog scales (range 0-100) at 1 to 2 hours, 2 to 4 hours, 8 to 12 hours, 20 to 28 hours, and 36 to 48 hours and the amount of acetaminophen consumed. Data were analyzed with Statistical Analysis System software using mixed-effects linear models., Results: Fifty-two patients were enrolled. Three patients were excluded due to incomplete follow up (n = 2) and postoperative course requiring early unblinding (n = 1). Twenty-six subjects were men. Average age was 68 years (range, 25-89). Eyelid procedures performed included blepharoplasty (18), canthoplasty (11), ptosis repair (15), eyelid retraction repair (2), pentagonal wedge resection (1), and MOHS reconstruction (2). Twenty-six patients were randomized to receive pregabalin, while the remainder received placebo. There was no significant difference in demographics between the 2 groups. The pregabalin group reported pain scores that were 5.5 points lower on average compared with the placebo group (p = 0.0307). Patients in the pregabalin group also consumed half as much acetaminophen (1.3 g) on average as the placebo group (2.6 g) during the postoperative period., Conclusions: Pregabalin is effective in reducing postoperative pain after oculoplastic procedures when compared with placebo. It may be a useful adjunct for pain control in selected patients.

Purpose: To investigate usage of soft contact lens (SCL) on post-operative pain relief and daily, activity due to pterygium surgery., Methods: Autograft pterygium surgery was performed to 63 eyes of 63 patients. After surgery in 30, eyes of 30 patients in group-1, SCL was placed on the cornea. In 33 patients of group-2, antibiotic, pomade was applied and tightly covered with bandage. Follow-up visits were performed on 24th and, 48th h after the surgery. Re-epithelization time and pain scores were compared., Results: Patients' 24th h pain score was 2.96 ± 0.76 in group-1, and 4.15 ± 0.75 in group-2. The mean, pain score for 48 h was 1.66 ± 0.66 in group-1, and 2.96 ± 0.68 in group-2. Patients' pain scores for, both 24th h and 48th h were lower in group-1 (p<0.01). The mean re-epithelization times in, group 1 and 2 were 48 and 56.7h, respectively. Corneal re-epithelization is improved in patients, with SCL compared to group 2., Conclusion: SCL seems effective on reducing post-operative pain and eye stinging, and may accelerate, corneal re-epithelization and maintaining daily activities., (Crown Copyright © 2013. Published by Elsevier Ltd. All rights reserved.)

Purpose: To evaluate the postoperative pain after corneal collagen cross-linking (CXL)., Methods: : This prospective study included 178 consecutive eyes of 135 patients with progressive keratoconus who underwent CXL at Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. Pain was assessed postoperatively using the need for analgesia with 30 mg of codeine (Tylex) and by the patients' subjective evaluation on the Wong-Baker FACES Pain Rating Scale at the end of each day until postoperative day (PO) 5. Correlation of postoperative pain with maximum keratometric reading and central corneal thickness, which were assessed preoperatively, was investigated., Results: Mean patient age was 23.38 ± 5.86 years. Mean (±SD) patient-scored pain decreased significantly (P < 0.05) from 2.78 (±1.68) on the day of surgery (immediate postoperative period, iPO) to 0.12 (±0.46) on PO5. The mean number of codeine pills was 0.94, 0.72, and 0.28 at iPO, PO1, and PO2, respectively, showing a significant decrease at each time point. Statistical analysis showed significant (P < 0.05) correlation between age and pain at PO3 and PO4 (the younger the patients the greater the pain) and between age and the number of codeine pills on iPO. There was no significant correlation between mean overall pain and preoperative apical keratometry (P = 0.546) and pachymetry (P = 0.072) readings., Conclusions: CXL postoperative pain can be intense, especially in the first 3 days, even with an aggressive pain control regimen; however, pain and the need for analgesia decreased significantly on each consecutive day. Pain was significantly correlated with the patient's age.

Background: The rationale of preemptive analgesia in ocular surgery is avoiding central sensitization because of nociceptive stimuli. The applicability in clinical practice has been argued because evidence for a relevant effect is missing. The present study attempts to demonstrate a clinically relevant pain reduction by preemptive peribulbar ropivacaine injection., Methods: Sixty patients scheduled for vitrectomy under general anesthesia between March and June 2007 were randomly assigned to receive 0.75% ropivacaine with 75 IU of hyaluronidase as peribulbar injection of 1, 3, or 5 mL before or 5 mL after surgery. Control subjects were 30 patients without any additional analgesic treatment. Groups were compared regarding procedure duration, consumed amount of analgesics during and after surgery, and pain 1, 3, and 24 hours postoperatively., Results: Postoperative pain was most marked in control subjects and in the group that received the injection after surgery. Before surgery, the dose of 5 mL of ropivacaine was most effective (postoperative pain median = 0), whereas patients who had received 1 mL or 3 mL reported some pain., Conclusion: The study highlights the benefit of the concept of preemptive analgesia in general: the peribulbar injection of 5 mL of 0.75% ropivacaine before surgery provides a substantial benefit in terms of analgesic demand and postoperative discomfort.

Purpose: To examine the efficacy and safety of nepafenac ophthalmic suspension 0.1% on postoperative inflammation and eye pain with intraocular surgery, other than cataract surgery., Patients and Methods: Patients scheduled to undergo vitreous surgery, trabeculectomy, laser iridotomy, laser trabeculoplasty and laser posterior capsulotomy were investigated in a multicenter, open-label study., Results: The total rate of patients cured in all the intraocular surgery methods was 85.6% (95/111), and that of the patients who were pain free was 91.0% (101/111). The rate cured by vitreous surgery was 80.4% (45/56), by laser iridotomy 93.3% (14/15) and by laser posterior capsulotomy was 94.6% (35/37). The rate of patients free from pain following vitreous surgery was 85.7% (48/56), laser iridotomy 100.0% (15/15) and by laser posterior capsulotomy was 94.6% (35/37). A total of 23 adverse events were reported in 22 patients (19.6%). Allergic conjunctivitis was observed in one patient (0.9%) as an adverse event, in which the relationship cannot be denied. This allergic conjunctivitis was mild and resolved after treatment., Conclusion: Nepafenac ophthalmic suspension 0.1% is considered safe and efficious not only following cataract surgery but also for postoperative inflammation and eye pain in intraocular surgery.

Purpose: To evaluate the effects of topical nepafenac in patients undergoing vitreoretinal surgery., Methods: One hundred and twenty eyes of 120 patients undergoing vitreoretinal surgery were randomized to receive either topical nepafenac 0.1% (60 eyes) or placebo (60 eyes) in this investigator-masked, randomized, comparative case series. Eyes were evaluated for Day 1 postoperative inflammation and 2-, 4-, 6-, and 8-week postoperative retinal thickness and best-corrected visual acuity., Results: Mean Day 1 inflammation grades of 0.95 ± 0.6 and 1.78 ± 0.7 were noted in patients taking nepafenac and placebo, respectively (P = 0.002). The nepafenac and placebo groups had mean central macular subfield thickness of 228.44 ± 29.27 μm and 236.21 ± 29.44 μm at 4 weeks (P = 0.172) and 205.35 ± 25.25 μm and 205.37 ± 24.90 μm at 8 weeks (P = 0.971), respectively. At 1 month, there was no statistically significant difference in the mean visual acuity between the nepafenac group (0.55 ± 0.16 decimal units) and placebo group (0.52 ± 0.17 decimal units)., Conclusion: Topical nepafenac was safe and reduced postoperative pain and inflammation in patients undergoing vitreoretinal surgery. However, its effect on reducing postoperative macular edema and improving visual acuity as compared with that of the standard postvitrectomy therapeutic regimen was equivocal.

Purpose: To evaluate the efficacy of pregabalin and gabapentin for reducing post-photorefractive keratectomy (PRK) pain., Methods: In this randomized clinical trial, 150 subjects undergoing PRK were allocated into 3 groups. In addition to the routine regimen, pregabalin 75 mg, gabapentin 300 mg, and placebo were administered 3 times daily for 3 days, in groups 1, 2, and 3, respectively. Subjects could take acetaminophen-codeine 300/10 mg tablets every 4 hours as needed. Patients completed a pain assessment survey (visual analogue scale ranging from 0 = no pain to 10 = most severe pain) 7 times in the first 3 days following PRK and also recorded the number of consumed acetaminophen-codeine tablets., Results: Age, sex, refractive error, ablation depth, and mitomycin-C (MMC) application were similar in the 3 study groups (all p values>0.05). Overall pain scores in the placebo group were 0.9 and 1 unit higher than the pregabalin (p=0.029) and gabapentin (p=0.023) groups, respectively. Severe pain (score >7) was more frequent in the placebo group on the morning of the first postoperative day (p=0.043). The difference in the number of consumed acetaminophen-codeine tablets was statistically borderline (p=0.061) and less in the pregabalin (7.9 ± 5.2) and gabapentin (9.0 ± 4.1) groups in comparison to the placebo group (10.3 ± 5.6)., Conclusions: Pregabalin and gabapentin seem to be helpful in alleviating post-PRK pain when combined with other measures. Depending on availability, either compound can be used as an adjuvant for pain control in this setting.