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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...

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Autores principales: Hafezi, Farhad, Hillen, Mark, Kollros, Leonard, Tan, Jerry, Awwad, Shady T.
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
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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.
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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
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