Intra-Operative Discomfort in Photorefractive Keratectomy

Abstract

Purpose

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

Abbreviations

FPS-R, Faces Pain Scale-Revised; LASEK, laser epithelial keratomileusis; LASIK, laser in situ keratomileusis; NRS, Numeric Rating Scale; PRK, photorefractive keratectomy; VRS, Verbal Rating Scale; WHASC, Wilford Hall Ambulatory Surgical Center.

Acknowledgments

Surgeries followed in this study were performed by Vasudah Panday, Robert Smith, Walter Steigleman, and James Richard Townley. Dr Matthew Caldwell advised as an associate investigator. Research optometrist Douglas Apsey assisted with statistical analysis. Kathleen Dinan served as the ophthalmic technician for patients enrolled in the study.

Disclosure

The authors have no conflicts of interest to disclose relating to this work.

Additional information

Funding

This investigation required no supplementary funding from Graduate Medical Education or extramural sources.