Use of topical nonsteroidal anti-inflammatory drugs in excimer laser photorefractive keratectomy

Nonsteroidal anti-inflammatory drugs (NSAIDs) produce potent analgesic, antipyretic, and anti-inflammatory effects. We studied postoperative pain in 97 consecutive patients having photorefractive keratectomy (PRK) by an excimer laser with different topical NSAID protocols. Treatment with topical homatropine hydrobromide, either diclofenac sodium (Voltaren Ophthalmic) or ketorolac tromethamine (Acular), and a soft contact lens was most effective in achieving post-PRK analgesia. We also studied post-PRK myopic regression in 68 consecutive patients and found that flurbiprofen sodium (Ocufen), when added to topical steroid protocols, significantly reduced myopic regression for one year postoperatively more than steroids alone or steroids and diclofenac sodium. Diclofenac, used with topical steroids, had less of an additive effect on myopic regression than did flurbiprofen. Topical NSAIDs are useful adjuncts to PRK therapy, both to eliminate postoperative pain and to control post-PRK myopic regression.