Cargando…
A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface
Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is no...
Autores principales: | , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9315572/ https://www.ncbi.nlm.nih.gov/pubmed/35887874 http://dx.doi.org/10.3390/jcm11144109 |
_version_ | 1784754595178741760 |
---|---|
author | Hafezi, Farhad Hillen, Mark Kollros, Leonard Tan, Jerry Awwad, Shady T. |
author_facet | Hafezi, Farhad Hillen, Mark Kollros, Leonard Tan, Jerry Awwad, Shady T. |
author_sort | Hafezi, Farhad |
collection | PubMed |
description | Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement. |
format | Online Article Text |
id | pubmed-9315572 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-93155722022-07-27 A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface Hafezi, Farhad Hillen, Mark Kollros, Leonard Tan, Jerry Awwad, Shady T. J Clin Med Article Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement. MDPI 2022-07-15 /pmc/articles/PMC9315572/ /pubmed/35887874 http://dx.doi.org/10.3390/jcm11144109 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Hafezi, Farhad Hillen, Mark Kollros, Leonard Tan, Jerry Awwad, Shady T. A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title | A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title_full | A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title_fullStr | A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title_full_unstemmed | A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title_short | A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface |
title_sort | new postoperative regimen after cxl and prk using topical nsaid and steroids on the open ocular surface |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9315572/ https://www.ncbi.nlm.nih.gov/pubmed/35887874 http://dx.doi.org/10.3390/jcm11144109 |
work_keys_str_mv | AT hafezifarhad anewpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT hillenmark anewpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT kollrosleonard anewpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT tanjerry anewpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT awwadshadyt anewpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT hafezifarhad newpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT hillenmark newpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT kollrosleonard newpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT tanjerry newpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface AT awwadshadyt newpostoperativeregimenaftercxlandprkusingtopicalnsaidandsteroidsontheopenocularsurface |