Diclofenac and Ketorolac in the Treatment of Pain after Photorefractive Keratectomy

ABSTRACT BACKGROUND: Photorefractive keratectomy (PRK) can produce significant ocular pain. Topical diclofenac, a non-steroidal anti-inflammatory drug (NSAID), is effective in the reduction of this pain. This study compares a second NSAID, ketorolac, to diclofenac. METHODS: This prospective matched-control study involved 102 eyes of 102 patients. Prior to PRK, patients were randomly assigned to receive ketorolac or diclofenac drops. At the first postoperative visit, a standardized questionnaire was used to assess the patient's average and peak levels of discomfort. In addition, the quantities of acetaminophen and codeine consumed were recorded. RESULTS: The overall level of discomfort was 1.53 ± 0.64 for diclofenac and 1.88 ± 0.55 for ketorolac (scale: 0 to 4)(P=0.004). The diclofenac group reported a peak discomfort level of 2.0 ± 0.75 and the ketorolac group reported 2.3 ± 0.62 (P > 0.05). The diclofenac group consumed 2000 ±1150 mg of acetaminophen and 92 ± 54 mg of codeine whereas the ketorolac group consumed 2150 ± 940 of acetaminophen and 98 ± 50 mg of codeine (P > 0.05). CONCLUSIONS: The differences in levels of peak discomfort, acetaminophen ingestion, and codeine ingestion, were not statistically significant. As compared to ketorolac, diclofenac resulted in a statistically significant lower mean overall discomfort. [J Refract Surg 1996;12:792-794].