Clinical Ophthalmology (Oct 2021)
Intra-Operative Discomfort in Photorefractive Keratectomy
Abstract
Samuel M Philbrick,1 John L Bennion2 1Department of Operational and Readiness Medicine, Joint Base Elmendorf-Richardson Hospital, Elmendorf, AK, USA; 2Department of Ophthalmology, Saint Alphonsus Health System, Boise, ID, USACorrespondence: Samuel M Philbrick Email [email protected]: Photorefractive keratectomy (PRK) remains a viable, safe, and efficacious option for patients wishing to correct refractive errors. One of its most significant drawbacks is pain. While post-operative pain has been well studied with different management options, intra-operative pain has been less well defined. The purpose of this study was to characterize intra-operative pain during PRK in regard to eye operated on, gender, excimer platform used, surgeon, and age.Patients and Methods: A total of 134 patients (264 eyes) were prospectively randomized to undergo bilateral PRK of either the right eye first or the left eye first followed immediately by the fellow eye. In the immediate post-operative period they were surveyed using an 11-point Numeric Rating Scale regarding intra-operative pain or discomfort experienced in each eye. Resultant pain scores were then analyzed via two sample z-test and analysis of variance (ANOVA) to characterize pain overall as well as comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, inter-surgeon variability, and age.Results: Of 264 eyes surveyed the mean pain experienced on a 0– 10 pain scale was 1.13 (minimal discomfort). There was no statistically significant difference in pain or discomfort when comparing first versus second eye operated on, right versus left eye, male versus female, excimer platform used, operating surgeon, or age.Conclusion: Intra-operative pain or discomfort experienced by patients is minimal. The absence of statistically significant differences in pain scores studied implies that standard of care procedures achieve adequate analgesia in PRK.Keywords: corneal refractive surgery, CRS, myopia, VISX, EX500, military medicine, inter-surgeon variability, order effect, PRK, laser in situ keratomileusis, LASIK, laser assisted sub-epithelial keratectomy, LASEK, z-test, pain, anesthetic, analgesia
