Grazia Maria Quaranta

A randomized, double-masked, clinical study of the efficacy of four nonsteroidal anti-inflammatory drugs in pain control after excimer laser photorefractive keratectomy.

OBJECTIVE This study assessed the efficacy of 4 nonsteroidal anti-inflammatory drugs (NSAIDs) after excimer laser photorefractive keratectomy (PRK). BACKGROUND Inadequate control of pain after PRK surgery can be a severe source of distress to patients and can interfere with their willingness to undergo a second PRK procedure. METHODS This randomized, double-masked, placebo-controlled clinical study was conducted in 125 patients. Four NSAIDs (diclofenac, flurbiprofen, ketorolac, and indomethacin) were tested against a placebo group (artificial tears). Pain levels after PRK were quantified using Present Pain Intensity (PPI) and Pain Rating Indices based on rank values (PRI[R]) scores, both of which were calculated using patient responses to a modified McGill Pain Questionnaire. The PRI(R) consisted of 4 subscales-sensory (S), affective (A), evaluative (E), and miscellaneous (M)-as well as a total score (T). RESULTS Three hours after PRK, no differences in PPI scores were found between the ketorolac, diclofenac, and indomethacin groups, whereas placebo was significantly less effective than the NSAIDs. Patients who received flurbiprofen reported PPI scores that were significantly lower (P < 0.001) than those of patients who received diclofenac and indomethacin, but PPI scores in the flurbiprofen and the ketorolac groups did not differ significantly. Twenty-four hours after surgery, patients treated with flurbiprofen, ketorolac, and diclofenac reported the lowest PPI scores compared with those treated with indomethacin and placebo (P < 0.001). Moreover, flurbiprofen-treated patients also had the lowest PRI(R)T scores (P < 0.001). When the pain rating index was examined by subclass, a significantly lower PRI(R)S score was detected in the flurbiprofen group at 24 hours (P < 0.001). The PRI(R)A score was significantly higher in the placebo and indomethacin groups compared with the other groups (P < 0.001). At the 48- and 72-hour time points, flurbiprofen-treated patients again reported significantly lower PPI and PRI(R)T scores (P < 0.001 for both) in pair-wise comparisons with the other treatment groups. The number of patients who self-administered additional oral analgesics did not differ significantly between the groups. However, the mean number of analgesic tablets used was significantly higher in the placebo group than in any NSAID group (P < 0.001). The ketorolac group had the largest number of patients complaining of itching (P < 0.043). No other subjective symptoms were significantly different across groups. Finally, all NSAIDs, except flurbiprofen, prolonged the mean reepithelialization period slightly (P < 0.001). CONCLUSIONS Flurbiprofen appeared to be the most effective NSAID for the treatment of pain, even at 24 hours after surgery when pain was at a maximum.

A randomised, double masked, clinical trial of high dose vitamin A and vitamin E supplementation after photorefractive keratectomy

AIM To evaluate the effect of a high dose vitamin A and E supplementation on corneal re-epithelialisation time, visual acuity and haze following photorefractive keratectomy (PRK). METHODS Two groups of 20 patients who underwent myopic PRK were supplemented with either 25 000 IU retinol palmitate and 230 mg α tocopheryl nicotinate or a placebo. Clinical outcomes were evaluated up to 360 days. RESULTS In the vitamin treated group, re-epithelialisation time was significantly faster (p=0.029) and haze incidence was reduced (p=0.035), especially for high myopic corrections (p=0.043). This group also reported a significantly better uncorrected visual acuity (p=0.043). CONCLUSIONS High dose vitamin A and E oral supplementation may accelerate re-epithelialisation time and may reduce corneal haze formation after PRK.

Contrast sensitivity measured by 2 methods after photorefractive keratectomy.

Purpose: To study contrast sensitivity in eyes that had flying‐spot excimer laser photorefractive keratectomy (PRK) and to compare a subjective method (Vision Contrast Test System [VCTS] 6500) and an objective method (visual evoked potential [VEP]) of measuring contrast sensitivity. Setting: Istituto Clinica Oculistica, Università degli Studi, Bari, Italy. Methods: Contrast sensitivity changes over time were evaluated in 26 eyes. The baseline values were compared with measurements 3, 6, and 12 months after PRK using the VCTS 6500 and VEP. Contrast threshold and VEP amplitude were classified by myopic correction. Results: Contrast threshold values changed significantly over time (P < .001). Significant differences were found between mean contrast threshold preoperatively and 12 months postoperatively (P < .001) at all spatial frequencies. A significant relationship was established between baseline and 12 month measurements at 18 cycles per degree. Mean VEP amplitude measurements also changed significantly over time (P < .001) and showed a significant relationship between baseline and 12 month measurements (P < .001). A significant relationship was also established between baseline and 12 month VEP amplitude values at 100% of grating contrast. Patients with high myopia complained significantly more at a lower contrast threshold and at lower VEP amplitude values than patients with low myopia. Conclusions: Three months after PRK, contrast threshold and VEP amplitude values were reduced. Partial recovery was established at 6 months, although patients reported permanent impairment under low‐contrast conditions, especially if the myopia correction was more than 6.0 diopters.

A randomized, comparative study of fluorometholone 0.2% and fluorometholone 0.1% acetate after photorefractive keratectomy.

Purpose To compare the efficacy and tolerance of fluorometholone 0.1% acetate and fluorometholone 0.2% eyedrops in the postoperative management of photorefractive keratectomy (PRK). Methods A randomised single-blind comparative study was performed on two groups of 30 patients who underwent myopic PRK. The first group was given fluorometholone 0.1% acetate and the second fluorometholone 0.2%. Uncorrected and best corrected visual acuity, haze, IOP and local tolerance were evaluated. Statistical analysis was done using parametric and non-parametric tests. Results Visual acuity did not differ in the two groups; both were homogeneous as far as refractive error and haze were concerned. Three patients (10%) treated with fluorometholone 0.2% and two patients (6.6%) with fluorometholone 0.1% acetate developed ocular hypertension, but this was not statistically significant. Conclusions Fluorometholone 0.1% acetate was effective on inflammation after PRK, with the same efficacy as fluorometholone 0.2%.

Choroidal neovascularization secondary to vitrectomy for idiopathic epiretinal membrane: Report of an unusual case

Purpose Epiretinal membranes (ERM) are a common finding in old patients. Pars plana vitrectomy is effective for removing ERM from the macula, but some postoperative complications are relatively frequent. In the present report, we describe a 73-year-old man in whom extrafoveal choroidal neovascularization developed four months after surgery. Methods Choroidal neovascularization was treated by argon laser photocoagulation. Results: Six months after treatment, the choroidal neovascularization was obliterated, with no recurrence of ERM. Conclusions Choroidal neovascularization can be an unusual complication of ERM surgery, and should be suspected in case of poor visual outcome or recurrence of symptoms.

Frequency-doubling perimetry after photorefractive keratectomy

Purpose: To evaluate the effect of photorefractive keratectomy (PRK) on frequency‐doubling perimetry (FDP) patterns in myopic patients without glaucoma. Setting: Department of Ophthalmology, University of Bari, Bari, Italy. Methods: Sixteen myopic patients (16 eyes) with a spherical equivalent worse than −7.0 diopters were enrolled. The fellow eyes were used as controls. All patients had PRK for myopia. Using FDP, the mean defect (MD) and pattern standard deviation (PSD) were evaluated preoperatively and 2 weeks and 3 and 6 months after PRK. At the same examinations, the effect of the reprofiled cornea on the visual field was studied; the cornea was divided into 4 concentric zones (central, paracentral, lateral, and peripheral) and each median zone contrast sensitivity (MZCS) evaluated. Results: There was no difference in PSD and MZCS between treated eyes and controls in any zone at any time (P > .05). Longitudinally, there was no variation in any perimetry zone (P > .05). In treated eyes, there was a significant relationship among ablation depth, MD, and MZCS in all zones until 2 weeks after laser surgery (P < .02). Conclusions: Frequency‐doubling perimetry did not appear to be affected by corneal changes induced by PRK and can therefore be safely used in the early diagnosis of glaucoma.