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    Preparing your patient for PRK

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


    Gabapentin has been found in some studies to decrease corneal pain. In a randomized masked placebo-controlled study,13 20 patients received 300 mg of gabapentin (Neurontin, Pfizer) for the first 72 hours postoperatively. These patients were compared to a matched placebo group, and both groups completed daily pain surveys. The gabapentin group had significantly less pain during the first 48 hours.13 Another study has shown less significant results.14

    Related: Managing LASIK complications

    Future of PRK treatment

    Clinicians continue to research techniques to speed the healing of the corneal epithelium, and decrease patient discomfort after PRK surgery. The combination of NSAIDS, bandage contact lenses, and oral pain medications have dramatically reduced the pain patients’ experience after PRK surgery.

    Unfortunately, pain is a very individual symptom, and some patients report a significant amount of pain after PRK surgery. It is always necessary to prepare your patient for the worst and hope for the best.


    1. Faktorovich EG, Basbaum AI. Effect of topical 0.5% morphine on postoperative pain after photorefractive keratectomy. J Refract Surg. 2010 Dec;26(12):934-41.

    2. Abri Aghdam K, Aghaei H, Shokrollahi S, Joshaghani M, Nazari H, Hashemi M, Ghaempanah MJ. Comparison of the effect of cycloplegic versus NSAID eye drops on pain after photorefractive keratectomy. J Curr Ophthalmol. 2016 Jan 8;27(3-4):87-91.

    3. Mohammadpour M, Jabbarvand M, Nikdel M, Adelpour M, Karimi N. Effect of preemptive topical diclofenac on postoperative pain relief after photorefractive keratectomy. J Cataract Refract Surg. 2011 Apr;37(4):633-7.

    4. Hong JP, Nam SM, Im CY, Yoon S, Kim TI, Kim EK, Seo KY. Comparison of analgesic effect of preoperative topical diclofenac and ketorolac on postoperative pain after photorefractive keratectomy. J Cataract Refract Surg. 2014 Oct;40(10):1689-96.

    5. Einollahi B, Baradaran-Rafii A, Rezaei-Kanavi M, Eslani M, Parchegani MR, Zare M, Feizi S, Karimian F. Mechanical versus alcohol-assisted epithelial debridement during photorefractive keratectomy: a confocal microscopic clinical trial. J Refract Surg. 2011 Dec;27(12):887-93.

    6. Torres LF, Sancho C, Tan B, Padilla K, Schanzlin DJ, Chayet AS. Early postoperative pain following Epi-LASIK and photorefractive keratectomy: a prospective, comparative, bilateral study. J Refract Surg. 2007 Feb;23(2):126-32.

    7. Lee HK, Lee KS, Kim JK, Kim HC, Seo KR, Kim EK. Epithelial healing and clinical outcomes in excimer laser photorefractive surgery following three epithelial removal techniques: mechanical, alcohol, and excimer laser. Am J Ophthalmol. 2005 Jan;139(1):56-63.

    8. Taneri S, Oehler S, MacRae S, Dick HB. Influence of a therapeutic soft contact lens on epithelial healing, visual recovery, haze, and pain after photorefractive keratectomy. Eye Contact Lens. 2016 Aug 30. [Epub ahead of print]

    9. Taylor KR, Caldwell MC, Payne AM, Apsey DA, Townley JR, Reilly CD, Panday VA. Comparison of 3 silicone hydrogel bandage soft contact lenses for pain control after photorefractive keratectomy. J Cataract Refract Surg. 2014 Nov;40(11):1798-804.

    10. Edwards JD1, Bower KS, Sediq DA, Burka JM, Stutzman RD, Vanroekel CR, Kuzmowych CP, Eaddy JB. Effects of lotrafilcon A and omafilcon A bandage contact lenses on visual outcomes after photorefractive keratectomy. J Cataract Refract Surg. 2008 Aug;34(8):1288-94.

    11. Engle AT, Laurent JM, Schallhorn SC, Toman SD, Newacheck JS, Tanzer DJ, Tidwell JL. Masked comparison of silicone hydrogel lotrafilcon A and etafilcon A extended-wear bandage contact lenses after photorefractive keratectomy. J Cataract Refract Surg. 2005 Apr;31(4):681-6.

    12. Eslampour A, Malaekeh-Nikouei B, Abrishami M, Bayani R. Efficacy of extended-release oral diclofenac in postoperative pain management after photorefractive keratectomy. J Ocul Pharmacol Ther. 2013 Sep;29(7):670-3.

    13. Lichtinger A, Purcell TL, Schanzlin DJ, Chayet AS. Gabapentin for postoperative pain after photorefractive keratectomy: a prospective, randomized, double-blind, placebo-controlled trial. J Refract Surg. 2011 Aug;27(8):613-7.

    14. Nissman SA, Tractenberg RE, Babbar-Goel A, Pasternak JF. Oral gabapentin for the treatment of postoperative pain after photorefractive keratectomy. Am J Ophthalmol. 2008 Apr;145(4):623-629.

    Read more from Dr. Owen here


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