Abstract
Purpose: :
To determine the rate of epithelial healing and degree of postoperative pain in eyes treated with either ketorolac tromethamine 0.4% (Acular LS) or nepafenac sodium 0.1% (Nevanac) following flapless surface ablation.
Methods: :
Prospective, randomized, double–masked, paired–eye comparison. Sixty eyes of 30 patients undergoing flapless surface ablation were randomized to receive ketorolac in one eye and nepafenac in the other. Drops were instilled immediately following the surgical procedure and patients continued to instill the masked drops 3 times daily for 5 days. Study follow–up visits were at days 1 and 5 post–operatively. Patients were also called on the phone and queried as to their level of pain at 5 hours post–operatively and on days 2, 3, and 4. Outcome measures included post–operative pain levels including need for additional rescue medications, rate of healing, and adverse events.
Results: :
In this interim analysis, eyes treated with nepafenac healed at a slower rate than eyes treated with ketorolac in 66% of patients. Mean time to healing in those patients was 5 days with ketorolac and 7.5 days with nepafenac. Patients also consistently reported more discomfort (pain, foreign body sensation, burning) in eyes treated with nepafenac than in eyes treated with ketorolac, though these differences were not statistically significant in the interim analysis (P<.05). At postoperative Day 2, the mean pain score was 1.7 with nepafenac and 0.7 with ketorolac and the mean burning score was 2.4 with nepafenac and 1.1 with ketorolac. Similarly, the mean foreign body sensation score was 2.7 with nepafenac and 1.7 with ketorolac.
Conclusions: :
Nepafenac therapy resulted in delayed healing compared with ketorolac. Ketorolac LS provided greater relief of patient pain and foreign body sensation following surface ablation than did nepafenac.
Keywords: laser • wound healing • quality of life