Pain Management in Corneal Collagen Crosslinking for Keratoconus: A Comparative Case Series.

Abstract

Purpose: To compare management of postoperative pain after corneal collagen crosslinking (CXL) with oral gabapentin or ketorolac. Methods: Prospective interventional comparative case series in a single center. Patients undergoing epithelium-off (epi-off) or epithelium-on (epi-on) techniques performed by a single surgeon for progressive keratoconus were enrolled and randomly assigned to the ketorolac (10-mg tablets every 8 h) or the gabapentin (300-mg capsules every 8 h) group and instructed to take the medication for the first 3 postoperative days. Using a numeric scale of pain, scores were assessed for current pain (at the time of applying the questionnaire), and average pain over the preceding 24 h. Eye symptoms and systemic adverse events related to oral medication were also assessed. Results: Thirty-seven patients were included, with 22 (10 epi-on and 12 epi-off) assigned to the ketorolac group and 15 (7 epi-on and 8 epi-off) to the gabapentin group. No statistically significant differences were noted on the pain scale between groups at any point of the study, in the median pain scores of patients at the time of applying the questionnaire, nor in the severity of pain during the 24-h period before the assessment. Also, no differences were found among groups for the eye symptoms and the systemic adverse events. The median regression analysis showed no effect of the type of surgery or gender in the severity of pain. Conclusions: Both oral ketorolac and oral gabapentin can be used with similar results for pain and symptomatic control after epi-on or epi-off CXL procedures.

• Authors: Juan Carlos Serna-Ojeda, Omar Santana-Cruz, Natalia Quiroz-Casian, Edgar González-Mendoza, José Luis Mercado-Orozco, Alejandro Navas, Alejandro Lichtinger, Enrique O Graue-Hernandez
• Journal: Journal of ocular pharmacology and therapeutics : the official journal of the Association for Ocular Pharmacology and Therapeutics (J Ocul Pharmacol Ther) 2019 Jul/Aug Vol. 35 Issue 6 Pg. 325-330 ISSN: 1557-7732 [Electronic] United States
• PMID: 31216215 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)

Chemical References

• Analgesics
• Anti-Inflammatory Agents, Non-Steroidal
• Cross-Linking Reagents
• Gabapentin
• Collagen
• Ketorolac

Topics

• Administration, Oral
• Adolescent
• Adult
• Analgesics (administration & dosage, adverse effects)
• Anti-Inflammatory Agents, Non-Steroidal (administration & dosage, adverse effects)
• Collagen (metabolism)
• Cornea (metabolism)
• Cross-Linking Reagents (administration & dosage)
• Female
• Gabapentin (administration & dosage, adverse effects)
• Humans
• Keratoconus (surgery)
• Ketorolac (administration & dosage, adverse effects)
• Male
• Pain Measurement
• Pain, Postoperative (drug therapy)
• Prospective Studies
• Surveys and Questionnaires
• Treatment Outcome
• Young Adult