Nepafenac Ophthalmic Suspension 0.3% for the Management of Ocular Pain After Photorefractive Keratectomy

Kontadakis, George A.; Chronopoulou, Konstantina G; Tsopouridou, Rodoula; Tabibian, David; Kymionis, George D.

doi:10.3928/1081597x-20180123-03

Cited by 9 publications

(5 citation statements)

References 21 publications

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“…A variety of medications and techniques have been proposed in an attempt to control PRK pain during and after surgery, starting from the preoperative instillation of topical anesthetics, the intraoperative copious irrigation with cold BSS [ 26 , 27 ], the application of soft bandage contact lenses at the end of surgery that can be soaked with analgesics or anesthetics [ 28 – 30 ] and the postoperative prescription of topical and oral anti-inflammatory analgesic medications including NSAIDs and steroids up to the use of systemic opioids in very severe pain [ 31 – 33 ]. Despite the relative analgesia achieved with these therapeutic agents or techniques, the level of patient satisfaction with post-PRK pain control strategies is still not high [ 34 ].…”

Section: Discussionmentioning

confidence: 99%

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

Abdel-Radi,

Eldaly,

Alattar

et al. 2023

Ophthalmol Ther

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Introduction Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. Methods In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. Results Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8 h after surgery, and 1, 2, and 3 days postoperatively ( P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups ( P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups ( P value > 0.05). Conclusion Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. Trial Registration ClinicalTrials.gov Identifier: NCT05733741.

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Section: Discussionmentioning

confidence: 99%

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

Abdel-Radi,

Eldaly,

Alattar

et al. 2023

Ophthalmol Ther

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“…Many strategies have been described to help minimize pain after PRK including bandage contact lenses, cold BSS, postoperative cold patches, NSAIDs, topical anesthetics, and opioids. [6][7][8][9][10][11][12]15,21,23,24 Even so, no established standardized approach to postoperative pain management exists. One study found a combination of topical anesthetic (amethocaine/tetracaine), topical diclofenac, and a bandage contact lens provided optimal postoperative pain management.…”

Section: Discussionmentioning

confidence: 99%

“…7 Topical NSAIDs have been studied extensively for pain control following PRK, but may be associated with side effects including burning, stinging, conjunctival hyperemia, punctate keratitis, and delayed epithelial healing. [8][9][10][11][12] Oral NSAIDs are used for analgesia in many fields of medicine and offer a potential alternative to the use of topical NSAIDs for post-PRK pain control. Although oral NSAIDs avoid the ophthalmic side effects associated with topical preparations, overuse may result in gastrointestinal, renal, or hepatic problems.…”

Section: Introductionmentioning

confidence: 99%

<p>Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs</p>

Ripa

Betts

Dhaliwal

et al. 2020

OPTH

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Purpose: To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal antiinflammatory drugs (NSAIDs). Patients and Methods: A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery. Results: The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p<0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p<0.0001). Pain scores 24-72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups. Conclusion: Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24-72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.

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“…Although it was negative in our case, allergic contact dermatitis (ACD) of the eyelids is more frequently an ectopic manifestation brought on by cosmetics used on the hair, face, scalp, or fingernails. There have been cases of ACD linked to eye drops, including glaucoma medications, antibiotics, antihistamines, steroids, and mydriatic eye drops, as well as eye drop ingredients or preservatives (6).…”

Section: Case Historymentioning

confidence: 99%

An Unusual Case of Allergic Contact Dermatitis Due to Nepafenac Eye Drop

KUMAR,

SUDHA,

KUMAR

et al. 2023

Maedica

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Eyelid dermatitis is a common occurrence in several skin disorders, including seborrheic dermatitis, atopic dermatitis and psoriasis. However, it is primarily associated with allergic contact dermatitis (ACD). Here, we present a case of 51-year-old woman who developed pruritic erythema of the eyelids after using 0.1% Nepafenac eye drops. Nepafenac is a non-steroidal anti-inflammatory drug (NSAID) commonly prescribed as eye drops for various inflammatory eye conditions. Instances of ACD caused by Nepafenac eye drops are exceedingly rare based on available case reports. Nevertheless, it is important to consider ACD as a potential cause when a patient with eyelid dermatitis has a history of Nepafenac eye drop usage. The Naranjo algorithm, which was used for assessing causality, determined the likelihood of this case being a possible instance of ACD due to Nepafenac (Naranjo score=3).

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Nepafenac Ophthalmic Suspension 0.3% for the Management of Ocular Pain After Photorefractive Keratectomy

Abstract: Nepafenac 0.3% ophthalmic suspension in a daily regimen after PRK seems to be an effective treatment for pain and ocular discomfort with effects similar to the 0.1% suspension. [J Refract Surg. 2018;34(3):171-176.].

Cited by 9 publications

References 21 publications

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

<p>Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs</p>

An Unusual Case of Allergic Contact Dermatitis Due to Nepafenac Eye Drop

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