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Pain relief after photorefractive keratectomy (laser eye surgery) is fundamental for patient well-being and recuperation. Hence, this study compared the various topical NSAIDs to determine the most effective therapeutic option.
Flurbiprofen is most useful for pain management and reepithelization after photorefractive keratectomy. However, other NSAIDs like Indomethacin, Ketorolac, and Diclofenac reduce rescue analgesic use more effectively.
Pain relief after photorefractive keratectomy (laser eye surgery) is fundamental for patient well-being and recuperation. Hence, this study compared the various topical NSAIDs to determine the most effective therapeutic option.
The systematic review and network meta-analysis analyzed data from 27 randomized controlled trials involving 2286 patients across 11 countries and focused on corneal reepithelization, rescue analgesic use, and pain levels from days 0 to 3 post-photorefractive keratectomy. Following Cochrane guidelines, a network meta-analysis was conducted using a frequentist approach to assess standardized mean differences (SMDs). Transitivity was checked via the net-split method. Effectiveness was ranked through forest plots versus placebo, with P-scores and league tables used for combined direct and indirect comparisons.
Out of 27 studies selected, NSAIDs like Ketorolac, Flurbiprofen, and Bromfenac showed significantly lower pain scores than placebo on day 0. Flurbiprofen consistently outperformed placebo on days 1, 2, and 3 for pain relief. Other NSAIDs showed substantial benefit compared to placebo only on the first postoperative day. Analysis of rescue analgesic use indicated that Indomethacin, Ketorolac, and Diclofenac were more effective. However, compared to placebo, reepithelialization was delayed with all NSAIDs except Flurbiprofen.
While Flurbiprofen was beneficial for tackling pain and promoting reepithelization on common postoperative days, the use of rescue analgesics indicated that other NSAIDs might offer better efficacy. The small sample size could explain these inconsistencies. For clinical decision-making, the effect sizes of NSAIDs must be judiciously examined.
Journal of Cataract and Refractive Surgery
Topical Non-Steroidal Anti-Inflammatory Drugs for Management of Pain after Photorefractive Keratectomy - a Systematic Review and Network Meta-Analysis
Dror Ben Ephraim Noyman et al.
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