Abstract
Purpose::
To compare efficacy and tolerability outcomes of ketorolac 0.4% and nepafenac 0.1% in patients undergoing photorefractive keratectomy (PRK).
Methods::
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.
Results::
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).
Conclusions::
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.
Clinical Trial::
www.clinicaltrials.gov NCT00405028
Keywords: clinical (human) or epidemiologic studies: treatment/prevention assessment/controlled clinical trials