Sher N A, Frantz J M, Talley A, Parker P, Lane S S, Ostrov C, Carpel E, Doughman D, DeMarchi J, Lindstrom R
Excimer Research Group, Phillips Eye Institute, Minneapolis, MN 55404.
Refract Corneal Surg. 1993 Nov-Dec;9(6):425-36.
Following excimer laser photorefractive keratectomy, patients experience significant ocular pain until corneal reepithelialization. Despite the use of cold compresses, bandage soft contact lenses, cycloplegics, narcotics, and topical corticosteroids, the pain has not been adequately controlled in many patients.
A randomized, double-masked, parallel-group study of diclofenac sodium 0.1% ophthalmic solution and its placebo vehicle was evaluated. Patients undergoing excimer myopic photorefractive keratectomy on their second eye were admitted overnight. Postoperative procedures included two drops of diclofenac or placebo immediately after surgery and then qid until reepithelialization, topical tobramycin (qid), 0.1% fluorometholone (q2h), cycloplegics, and a disposable soft contact lens. Thirty-two patients (diclofenac = 16, placebo = 16) were evaluated from +30 minutes to +96 hours by several types of questionnaires.
Most patients who received placebo experienced pain, starting within 1 hour, peaking at 4 to 6 hours and lasting 36 to 48 hours. The diclofenac-treated patients rarely experienced the early peak in pain, had less pain overall until 72 hours postoperatively, and experienced significantly less photophobia and burning/stinging. Significantly fewer patients on diclofenac required oral narcotics. Three patients (diclofenac = 2, placebo = 1) developed corneal infiltrates, the etiology of which is not known. In a separate study we conducted, there was no difference in epithelial healing times between the diclofenac-treated eyes and those not receiving the drug.
Diclofenac appears to significantly reduce the ocular pain following excimer photorefractive keratectomy.
准分子激光角膜切削术后，患者在角膜再上皮化之前会经历明显的眼痛。尽管使用了冷敷、绷带软性角膜接触镜、睫状肌麻痹剂、麻醉剂和局部皮质类固醇，但许多患者的疼痛仍未得到充分控制。
对0.1%双氯芬酸钠滴眼液及其安慰剂载体进行了一项随机、双盲、平行组研究。接受准分子近视角膜切削术的患者的第二只眼睛需住院一晚。术后处理包括术后立即滴两滴双氯芬酸或安慰剂，然后每天四次直至再上皮化，局部用妥布霉素（每天四次）、0.1%氟米龙（每两小时一次）、睫状肌麻痹剂和一次性软性角膜接触镜。通过几种类型的问卷对32名患者（双氯芬酸组 = 16名，安慰剂组 = 16名）从术后30分钟至96小时进行评估。
大多数接受安慰剂的患者在1小时内开始疼痛，4至6小时达到峰值，持续36至48小时。接受双氯芬酸治疗的患者很少经历疼痛的早期峰值，术后72小时内总体疼痛较轻，畏光和烧灼感/刺痛感明显较少。服用双氯芬酸的患者需要口服麻醉剂的人数明显较少。三名患者（双氯芬酸组 = 2名，安慰剂组 = 1名）出现角膜浸润，其病因不明。在我们进行的另一项研究中，双氯芬酸治疗的眼睛与未接受该药物治疗的眼睛在上皮愈合时间上没有差异。
双氯芬酸似乎能显著减轻准分子激光角膜切削术后的眼痛。
