Effect of Topical Nepafenac Treatment on Perioperative and Postoperative Pain Relief and Epithelial Healing After CXL
Purpose
to evaluate the safety and efficacy of topical nepafenac %0.1 on pain control and corneal epithelial healing in patients undergoing crosslinking treatment
Methods
In this randomized prospective study, 31 patients who were undergoing epithelium-off CXL received nepafenac %0.1 t.i.d. the day before, 1 drop on the morning of CXL and t.i.d. daily until re-epithelialization was achieved. 28 patients undergoing CXL treatment served as no-treatment control group. A bandage lens was placed on the eye in both groups after the procedure. Pain was evaluated with verbal analog scale intraoperatively and patients were asked daily to assess the level of pain using a visual analog scale (VAS) postoperatively. The frequency of usage of topical anesthetic drops during the CXL procedure, and corneal re-epithelialization rate were also recorded.
Results
There was no statistically significant difference in the peri-operative pain scores. The frequency of usage of topical anesthetic drops was significantly lower in the nepafenac group (1.7±1.9 vs.2.6±1.8 drops, p=0.04) as well as the pain scores on the post-operative day 1 (4.5±2.1 vs. 6.8±3.2,p=0.002) and 2(3.1±1.9 vs. 5.3±2.6, p=0.001). Epithelial healing was not completed on post-operative day 3 in 5/31(16%) patients in the nepafenac group and in 4/28 (14%) patients in the control group (p=0.84). Complete re-epithelialization was achieved by post-operative day 4 in all patients. No complications were observed except the occurence of a sterile corneal infiltrate in one eye in the nepafenac group that resolved quickly without visual sequela.
Conclusion
Topical nepafenac treatment reduces pain in the immediate postoperative period after crosslinking and does not have an adverse effect on corneal epithelial healing.