Abstract
Objective:To compare post-operative pain relieving effect of topical diclofenac 0.1% versus ketorolac 0.5% in Corneal Collagen Cross Linking (CXL) for patients diagnosed with keratoconus.Methods:This randomized controlled trial was carried out for six months from October 2016 to March 2017. We included young patients having keratoconus with k-readings greater than 47D and central corneal thickness more than 400 microns. All the patients received single dose one drop of topical diclofenac 0.1% to (Group-A) and ketorolac 0.5% to (Group-B) 30 minutes in advance of the corneal collagen cross linking (CXL) procedure. The CXL was performed with topical 0.1% riboflavin eye drops in 20% dextran as a photo sensitizer. After 36 hours of the CXL procedure, the postoperative intensity of pain was assessed verbally by patients with the help of visual analog scale (VAS) numbers from zero to five where 0 designated no pain & 5 symbolized worst pain.Results:The study comprised sixty eyes of forty one patients. Out of total 16 were male while 25 female patients. The mean age of the patients was 24.27 ± 2.93 years (range 20 to 29 years). In the conclusive analysis, diclofenac 0.1% was used on 30 patients in Group-A and ketorolac 0.5% on 30 subjects in Group-B. Pain relieving scores in Group-A (diclofenac 0.1%) was 2.57 ± 0.67 while in Group-B (ketorolac 0.4% treated arm) was 3.20 ± 0.61.Conclusion:Topical diclofenac 0.1% is statistically comparable to topical ketorolac 0.5% in precluding severity of pain after corneal collagen cross linkage operation.
Highlights
Keratoconus is a non-inflammatory progressive disease characterized by conical cornea inducing myopic irregular astigmatism
Both the groups were comparable in terms of gender and age
In two patients pain progressed to intermediate grade, after mean duration of 6.50 ± 0.70 hours post op in Diclofenac group versus 30 eyes progressing to intermediate pain in ketorolac group earlier than diclofenac group
Summary
Keratoconus is a non-inflammatory progressive disease characterized by conical cornea inducing myopic irregular astigmatism. Keratoconus affects both the sexes and its onset of generally occurs at puberty.[1] The global incidence of keratoconus in general population is estimated to be 1 in 2000.2 Corneal collagen cross-linkage (CXL) was introduced by Eberhard Spoesi and Theo Seiler in 1990 as treatment of keratoconus.[3] This is a quite reputed method of refractive surgical intervention which crops cross linking of collagen using Riboflavin (Vit-B2) and ultraviolet-A (UVA). Pak J Med Sci September - October 2017 Vol 33 No 5 www.pjms.com.pk 1101 irradiation. The outcome is triggering of natural lysl oxidase pathway, that effects immediately after irradiation leading to an increase of the biomechanical rigidity of the cornea of about 300%.4. The outcome is triggering of natural lysl oxidase pathway, that effects immediately after irradiation leading to an increase of the biomechanical rigidity of the cornea of about 300%.4 Recent management protocol entails use of UV-A energies of 3 mW/cm[2] for about 30 min to gain clinical benefits.[4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
