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S. Tauber, W. Trattler, J. Luchs, P. Majmudar; A Randomized, Double-Masked, Contralateral Eye Clinical Evaluation of Ketorolac 0.4% versus Nepafenac 0.1% in PRK Patients. Invest. Ophthalmol. Vis. Sci. 2007;48(13):5350.
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To compare efficacy and tolerability outcomes of ketorolac 0.4% and nepafenac 0.1% in patients undergoing photorefractive keratectomy (PRK).
Randomized, double-masked, contralateral eye study. Patients (n = 32) underwent PRK, received bandage contact lenses (BCLs), and were randomized to ketorolac in one eye and nepafenac in the other for 4-5 days. Drops were instilled in patients before or after the BCL application, but in most patients (78%) drops were instilled after the BCL was applied. Patients rated their symptoms and pain immediately postoperatively, at 2 hours, 6 hours, and daily until the epithelium healed. Corneal haze was evaluated at week 2 and months 1, 2, and 3. Healing was evaluated on the day the BCL was removed.
Patients at Day 4 (17 of 20, 85%) rated their ketorolac-treated eye as "better" than their nepafenac-treated eye; at Day 5, of the 18 patients that completed the questionnaire, 91% (10 of 11) reported that their ketorolac-treated eye was "better." No between-group differences in symptoms were reported. Nepafenac-treated eyes displayed significantly more haze at week 2 (P = .026), month 1 (P = .014), and month 2 (P = .019) than did ketorolac-treated eyes. At week 2, 6 nepafenac-treated eyes had haze rated as 1+ and 1 was rated as trace, compared with only 2 ketorolac-treated eyes that exhibited trace haze. Ketorolac-treated eyes healed faster (4.7 days vs. 5.1 days with nepafenac), but this difference was not statistically significant (P = .137).
These findings suggest that ketorolac 0.4% may provide superior outcomes after PRK than nepafenac 0.1% in terms of patient comfort, level of haze and rate of re-epitheliazation. These findings also support other studies that have demonstrated that nepafenac should be used cautiously following surface ablation procedures.
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