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A. Ghirlando, E. Midena, A. Leonardi, C. Gambato, F. Busato, A.G. Secchi; NONSTEROIDAL ANTIINFLAMMATORY DRUGS AFTER EXCIMER LASER PHOTOREFRACTIVE KERATECTOMY (PRK):A RANDOMIZED DOUBLE BLIND STUDY . Invest. Ophthalmol. Vis. Sci. 2004;45(13):167.
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Purpose: To compare the role of two nonsteroidal antiinflammatory drugs in the prevention of postoperative pain and modulation of corneal wound healing after PRK. Methods: 40 eyes of 20 patients (5 males, 15 females) were enrolled in a double masked study aiming to compare efficacy and side effects of two nonsteroidal antiinflammatory drugs topically applied post PRK (pranoprofen 0.1% vs diclofenac 0.1%). Preoperative evaluation included: UCVA, BCVA, refraction, biomicroscopy, corneal confocal microscopy and topography. Follow–up was performed daily for four days and at 1 month postop. Postoperatively functional recovery, corneal reepithelization sequence, pain score and corneal wound healing by corneal confocal microscopy were evaluated. All patients received pranoprofen 0.1% qid for 4 days in one eye (Group 1) and diclofenac 0.1% qid for 4 days in the fellow eye (Group 2). Results:20 patients with mean myopia of –3.67± 1.84 diopters (range: 1– 6.75 D) and difference ± 0.75 D between each patient’s eyes, were treated by PRK in a standard fashion. Functional results (UCVA, BCVA, refraction) were not statistically significant between the two groups at any follow–up examination time (p=.083). Less postoperative pain was reported in group 1 vs group 2 eyes (p=.017). At third postop day all cornea were fully reepithelized in 99.9% vs 93.75% in the two groups, respectively (p=.009) and corneal confocal microscopy documented thinner epithelium in group 2 vs group 1 (p=.007). Group 1 eyes showed less extracellular matrix production and keratocytes activation in anterior stroma compared to group 2 at 3 days post PRK (p=.003). Conclusions:Pranoprofen 0.1% seems more effective than diclofenac 0.1% in reducing postoperative pain after PRK. Moreover, pranoprofen 0.1% allows earlier corneal reepithelialization and seems to modulate early corneal wound healing response. No late side effects were observed. Nonsteroidal antinflammatory drugs are frequently used after PRK. Refractive surgeon should consider early and late beneficial vs detrimental effect of any specific drug used in the postoperative period after PRK.
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