Abstract
The aim of our present study is to evaluate the efficacy of pranoprofen eye drops as pain relief during sequential second-eye cataract surgery and to investigate the possible mechanism. Seventy-six patients scheduled for bilateral sequential cataract surgery were randomly assigned to two groups: (1) treatment group (administered pranoprofen eye drops), or (2) control group (administered artificial tears). Preoperative anxiety and intraoperative pain were assessed. Monocyte chemoattractant protein 1 (MCP-1) in the aqueous humor was measured with a suspension cytokine array. An extracapsular lens extraction model was established in the Wistar rat and the MCP-1 concentrations were measured with an enzyme-linked immunosorbent assay. We found that in the control group, the pain scores were significantly higher during second-eye surgery than during first-eye surgery (both scores P < 0.001). In the treatment group, there was no significant difference in the pain scores during first-eye and second-eye surgery (both scores P > 0.1). The pain during second-eye surgery was significantly lower in the treatment group than in the control group (both scores P < 0.01). And in the 1-week and 6-week interval subgroups, the pain scores during second-eye surgery were significantly lower in the treatment group than the control group (P = 0.047 and P = 0.035, respectively). While the second-eye MCP-1 level was significantly lower after a 1-week interval in the treatment group than in the control group (P = 0.012), but did not differ significantly after a 6-week interval (P > 0.1). A parallel trend in the MCP-1 concentration was detected in the rat model. In conclusion, the preoperative administration of pranoprofen eye drops reduced the perceived pain during second-eye cataract surgery, especially when performed after 1-week and 6-week intervals between the first-eye and second-eye surgery. MCP-1, a pain-related cytokine, was associated with the pain-relief mechanism of pranoprofen when second-eye surgery was performed 1 week after second-eye surgery.
Highlights
Phacoemulsification with intraocular lens (IOL) implantation under topical anesthesia is widely performed to treat cataract (Fichman, 1996)
There was no significant difference in the pain scores during first-eye surgery between the treatment and control groups, the scores for second-eye surgery were significantly lower in the treatment group than in the control group (PVAS = 0.004 and PWBS = 0.006; Figure 1A)
In this study, we evaluated the effects of administering pranoprofen eye drops for pain relief during sequential second-eye cataract surgery, and investigated the associated molecular mechanism, which was verified in the extracapsular lens extraction (ECLE) rat model
Summary
Phacoemulsification with intraocular lens (IOL) implantation under topical anesthesia is widely performed to treat cataract (Fichman, 1996). Intraoperative pain might reduce the patient’s willingness to cooperate during surgery and their satisfaction with surgery, and this increases the difficulty of surgery. The requirement for pain relief increases during second-eye surgery. Nonsteroidal antiinflammatory drugs (NSAIDs) exert potent analgesic effects by inhibiting the biosynthesis of prostaglandins, which normally sensitize the pain nerve endings (McCormack and Brune, 1991; Sher et al, 1993). Two clinical trials have demonstrated that bromfenac eye drops reduce ocular inflammation and pain after cataract surgery (Donnenfeld et al, 2007). NSAIDs have been used to reduce pain after photorefractive keratectomy (PRK) (Faktorovich and Melwani, 2014). The effects of preoperative NSAIDs on pain relief during sequential second-eye cataract surgery are unclear
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