Effect of topical diclofenac on postoperative photorefractive keratectomy pain: a randomized, controlled trial

Abstract

Background: A major disadvantage of photorefractive keratectomy is postoperative pain and discomfort. This study aims to evaluate whether topical diclofenac 0.1% therapy adds any extra benefit to systemic diclofenac in controlling pain after photorefractive keratectomy.

Design: Prospective randomized, double-masked clinical trial applied in the Khatam-al-Anbia Eye Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.

Participants: Sixty-eight individuals (age range, 18-35 years) having bilateral photorefractive keratectomy for myopic correction with or without astigmatism.

Methods: All patients received 100 mg of extended-release oral diclofenac two times (12-h interval) before photorefractive keratectomy surgery. Postoperatively, patients were randomized into the case and control groups. Case group was administered the diclofenac 0.1% drop, one drop 2 h preoperatively and four times daily postoperatively for 3 days, whereas the control group was given artificial tears instead.

Main outcome measures: Pain level, photophobia and functional activity were evaluated by the patient after operation.

Results: Two days after surgery, no statistically significant difference in pain level was noted between both groups. In addition, photophobia and functional activity was not different between the case and control groups. Eyelid oedema and conjunctival injection levels were significantly higher in the control group (P < 0.001).

Conclusions: Administration of topical diclofenac to a standardized postoperative pain regime did not alleviate post-photorefractive keratectomy pain, although it is effective in local signs like eyelid oedema and conjunctival injection. It can be concluded that oral diclofenac is sufficient in the management of post-photorefractive keratectomy pain and addition of the topical diclofenac is unnecessary.

Keywords: cornea; diclofenac; pain; photorefractive keratectomy.