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ABSTRACT
BACKGROUND: Photorefractive keratectomy (PRK) can produce significant ocular pain. Topical diclofenac, a non-steroidal anti-inflammatory drug (NSAID), is effective in the reduction of this pain. This study compares a second NSAID, ketorolac, to diclofenac.
METHODS: This prospective matched-control study involved 102 eyes of 102 patients. Prior to PRK, patients were randomly assigned to receive ketorolac or diclofenac drops. At the first postoperative visit, a standardized questionnaire was used to assess the patient's average and peak levels of discomfort. In addition, the quantities of acetaminophen and codeine consumed were recorded.
RESULTS: The overall level of discomfort was 1.53 ± 0.64 for diclofenac and 1.88 ± 0.55 for ketorolac (scale: 0 to 4)(P=0.004). The diclofenac group reported a peak discomfort level of 2.0 ± 0.75 and the ketorolac group reported 2.3 ± 0.62 (P > 0.05). The diclofenac group consumed 2000 ±1150 mg of acetaminophen and 92 ± 54 mg of codeine whereas the ketorolac group consumed 2150 ± 940 of acetaminophen and 98 ± 50 mg of codeine (P > 0.05).
CONCLUSIONS: The differences in levels of peak discomfort, acetaminophen ingestion, and codeine ingestion, were not statistically significant. As compared to ketorolac, diclofenac resulted in a statistically significant lower mean overall discomfort. [J Refract Surg 1996;12:792-794].
The 193-nm excimer laser has been effective in the treatment of myopia.1"3 Eye discomfort is a frequent finding in the first 24 hours following PRK.4 Randomized studies have demonstrated the efficacy of diclofenac over placebo in reducing ocular discomfort and the need for oral narcotics following PRK4 Ketorolac is another topical NSAID drop in common clinical use. Both NSAIDs have been used to reduce ocular inflammation following cataract surgery.5,6 This prospective, randomized, matchedcontrol study was conducted to compare the relative efficacy of diclofenac and ketorolac in reducing pain following PRK.
PATIENTS AND METHODS
Study Design
Informed consent was obtained from 102 consecutive patients who were prospectively enrolled in this study. A Summit Technology Excimed UV200 excimer laser was used (Summit Technology, Waltham, MA). This 193-nm laser has a pulse rate of 10 Hz, a fluency at the corneal surface of 180 mj/cm2, and a nominal ablation rate of 0.25 µt? per pulse. The ablation zone was 5.0 mm. The instrument...