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    Preparing your patient for PRK

    Manage, set patients’ expectations for pain pre- and post-op

    Photorefractive keratectomy (PRK) was the original excimer laser procedure approved by the FDA—and is still a safe and effective treatment of refractive errors. PRK has the benefits of no-flap creation; therefore, there is no risk of flap complications. In PRK, the treatment of the stromal bed is more shallow as compared to LASIK, resulting in less risk of ectasia.

    Short-term postoperative pain and slower visual recovery are disadvantages of this type of refractive surgery. Over the years, variations in pre-operative care, surgical treatment, and postoperative care have been evaluated, including the use of topical morphine to alleviate postoperative pain.1

    Previously from Dr. Owen: Ocular surface disease limits surgical options

    PRK requires the removal of approximately 8 mm in diameter of corneal epithelium (Figure 1). This large epithelial defect leaves corneal nerves exposed, resulting in significant pain and discomfort for the patient. This defect usually heals within three to five days.

    Corneal epithelial defect

    Managing postoperative pain

    While I contend that males above 6 feet 3 inches have the worst pain, no published literature supports this repeated observation. It would be great if we could predict which patients would have the most pain after surgery.

    Researchers have looked for predictors including age, race, spherical equivalent, and even anxiety scores without any correlation to pain.2

    It is important to inform all patients undergoing PRK that they will experience some pain in the immediate postoperative period. It is better for the patient to experience less pain than you describe, not more.

    Related: Managing presbyopia with surgery

    The treatment of PRK pain can start prior to surgery. Studies show starting a non-steroidal anti-inflammatory (NSAID) drops prior to surgery decreases postoperative pain.3 In a randomized masked trial, patients were administered a drop of diclofenac 0.1 percent (Voltaren, Novartis) in one eye and one drop of placebo in the other eye two hours before PRK. Postoperatively, both eyes of each patient received topical diclofenac every six hours for two days.3

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