Preoperative Topical Diclofenac and Ketorolac in Prevention of Pain and Discomfort Following Photorefractive Keratectomy: A Randomized Double-Masked Placebo-Controlled Clinical Trial

Objectives: to compare the efficacy of a single dose of topical diclofenac0.1% and ketorolac 0.5%, with placebo and with each other inthe prevention of post-prk pain and discomfort.methods: in this randomized double-masked trial, adults undergoingbilateral prk surgery were assigned to two arms. the first arm receiveda single dose diclofenac 0.1%, randomly in either the right, orleft eye, and artificial tear (as the placebo) in the other eye. the secondarm received ketorolac 0.5%, by the same pattern. the primary outcomeof this study was ocular[1] pain assessed by visual analogue scale(vas), and,[2] discomfort including itching, foreign body sensation,tearing and photophobia which were questioned in 4 degrees.results: in the final analysis, 47 and 36 subjects remained in the diclofenacand ketorolac treated arms, respectively. in both arms, on thefirst and second post-operation days, vas scores were significantlylower in the pretreated eye. moreover, on the first post-operation day,the intensity of all ocular discomfort items was statistically lower in thepretreated eyes; whereas, on the second day, such a difference was onlyobserved for foreign body sensation and itching in the diclofenactreated arm and for photophobia in ketorolac treated arm. comparisonof the two arms (diclofenac pretreated eyes vs. ketorolac pretreatedeyes) on both first and second post-operation days showed no significantdifference neither in the vas scores nor the ocular discomfortitems.conclusions: either diclofenac or ketorolac instilled at a dose of onedrop 30 minutes in advance of the operation would be equally beneficialin the short-term prevention of post-prk pain and discomfort.