Postoperative Pain Comparison Between Alcohol-Assisted and Transepithelial Photorefractive Keratectomy Using Nepafenac Treatment: A Novel Study

Nir Gomel; Nadav Shemesh; Nir Sorkin; Nadav Levinger; Shmuel Levinger; Ami Hirsch; Asaf Achiron; Eliya Levinger

doi:10.1007/s40123-024-01040-8

Postoperative Pain Comparison Between Alcohol-Assisted and Transepithelial Photorefractive Keratectomy Using Nepafenac Treatment: A Novel Study

Ophthalmol Ther. 2024 Dec;13(12):3049-3057. doi: 10.1007/s40123-024-01040-8. Epub 2024 Oct 3.

Authors

Nir Gomel^#¹, Nadav Shemesh^#^{2

3}, Nir Sorkin², Nadav Levinger⁴, Shmuel Levinger⁴, Ami Hirsch⁴, Asaf Achiron^{2

4}, Eliya Levinger^{2

4}

Affiliations

¹ Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel. nir.gomel1@gmail.com.
² Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, 6423906, Tel Aviv, Israel.
³ The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁴ Enaim Medical Center, Tel-Aviv, Israel.

^# Contributed equally.

Abstract

Introduction: The study aimed to compare postoperative pain between alcohol-assisted and transepithelial photorefractive keratectomy in patients who received the novel analgesic preoperative nepafenac treatment 2 days preoperatively and 3 days postoperatively. Pain, stinging, tearing, light sensitivity, and stress levels were evaluated.

Methods: The study included a retrospective analysis of 55 patients divided into two groups: bilateral alcohol-assisted photorefractive keratectomy (aa-PRK) and transepithelial photorefractive keratectomy (transepithelial-PRK). Nepafenac was administered for pain control for all patients, with patients receiving four drops for 2 days before the surgery and 3 days postoperatively per clinical instructions. Patients completed questionnaires on the day of the surgery and for the first 5 days postoperatively. Statistical analysis was performed using XLSTAT (version 2023.1.2). t-Test was used to analyze and compare pain and symptom levels and Fisher's exact test for categorical data. p-Values less than 0.05 were considered statistically significant.

Results: The study examined 55 patients (49% female) with a mean age of 25.11 ± 6.81 years who had undergone bilateral surface refractive surgery to correct myopic errors. The mean baseline standard error (SE) was -3.16 ± 2.20 D. Among these patients, 27 patients underwent aa-PRK and 28 patients underwent transepithelial-PRK. Higher levels of pain were significant in the aa-PRK group (p = 0.003). However, there was no significant difference between the groups in the average levels of stinging, tearing, or light sensation. Additionally, stress levels decreased over time in both groups, with levels becoming almost equal after 5 days, and there was no significant difference in the average stress levels between the two groups.

Conclusions: The study found that patients who underwent the transepithelial-PRK procedure had significantly lower pain levels compared with those who underwent aa-PRK after being treated with nepafenac per protocol. However, there was no significant difference between the two groups in terms of stinging, tearing, light sensation, and stress levels.

Keywords: Analgetic; Nepafenac; Nevanac; Nonsteroidal antiinflammatory drug (NSAID); Pain; Photorefractive keratectomy (PRK); Postoperative adverse events; Refractive surgery.