ESCRS - FPS07.12 - Pain Management Protocol In Photorefractive Keratectomy And Crosslinking: Cold To The Rescue

Pain Management Protocol In Photorefractive Keratectomy And Crosslinking: Cold To The Rescue

Published 2022 - 40th Congress of the ESCRS

Reference: FPS07.12 | Type: Free paper | DOI: 10.82333/a04x-je17

Authors: Sailie Shirodkar* 1 , Rohit Shetty 2 , Arkasubhra Ghosh 3 , Swaminathan Sethu 3 , Pooja Khamar 1 , Nikhil Ashok 3

1Cataract and Refractive Services,Narayana Nethralaya, Bangalore,Bangalore,India, 2Cornea and Refractive Services,Narayana Nethralaya, Bangalore,Bangalore,India, 3GROW Labs,Narayana Nethralaya, Bangalore,Bangalore,India

Purpose

To compare post-operative pain perception in subjects using bandage contact lens (BCL) stored at 2 – 8⁰C (Cold BCL, CL-BCL) or at room temperature (23 – 25⁰C, RT-BCL), with or without ketorolac tromethamine 0.4% (KT), immediately after photorefractive keratectomy (PRK) or corneal collagen-crosslinking (CXL) and determine status of key nociception associated factors

Setting

Narayana Nethralaya Superspeciality Eye Hospital, Bangalore, India

Methods

Sixty-eight subjects (136 eyes) undergoing PRK for refractive correction and 248 subjects with progressive keratoconus (KC) undergoing CXL were randomly divided into: Conventional (BCL maintained at room temperature – RT, 24⁰C), Conventional+KT (BCL with 0.4% KT  maintained at RT), Cold (BCL maintained at 4⁰C in a refrigerator) and Cold+KT (BCL with 0.4% KT maintained at 4⁰C in a refrigerator). Pain was assessed by Wong-Baker (WB) scoring on the first post-operative day (PoD-1). POD-1 BCLs were collected from 20 PRK patients receiving Cold BCL in one eye and RT-BCL in the other, to measure expression of transient receptor potential channels (TRPV1, TRPA1, TRPM8), Calcitonin gene-related peptide (CGRP) and IL-6.

Results

Cold (Mean WB Score ± SD: 3.4 ± 2.9) and Cold+KT (2.7 ± 2.6) had significantly (P<0.0001) low pain compared to Conventional group (7.43 ± 1.6) but not compared to Conventional + KT (4.76 ± 2.65) in PRK. Cold (3.08 ± 2.1) and Cold+KT (2.28 ± 2.4) had significantly (P<0.0001) low pain compared to Conventional (7.28 ± 1.8) and Conventional+KT (5.32 ± 2.7) in CXL. TRPM8 expression was significantly (P<0.05) increased in BCL of subjects reporting reduced pain with CL-BCL compared to those who did not. There was no significant difference in epithelial healing time as assessed on slit lamp examination over the course of 3 days. None of the patients developed signs of infection post-operatively.

Conclusions

Acceptance of these procedures amongst patients and surgeons alike, is limited considerably due to significant post-operative pain. This simple and economical approach promises to be effective in controlling post-operative pain and increase patient comfort with no delay in epithelial healing. It thereby aims to increase acceptance of these highly beneficial procedures amongst patients and surgeons alike.