Transcript pain

Catarinense Center for
Keratoconus Treatment
Pattern of Pain and Analgesic use after
Collagen Crosslinking for Progressive
Keratoconus
Ramon Coral Ghanem, MD, PhD.
Renan Ferreira Oliveira, MD.
Vinicius Coral Ghanem, MD, PhD.
Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil.
The authors have no financial interest in the subject matter of this poster.
Purpose
• To evaluate postoperative pain after standard riboflavinultraviolet-A corneal collagen crosslinking (CXL)*.
*Riboflavin/UV-A CXL has not been approved by the U.S. FDA.
Methods
• Prospective study including consecutive eyes with
progressive keratoconus that underwent CXL.
• Pain was assessed at the end of each day from the day of
surgery (day 0) until day 5 using:
– the Wong-Baker FACES Pain Rating Scale1 (graduated from 0 to 5);
– the need for oral opioid analgesic use (codeine 30mg).
1Wong
DL et al. Wong’s Essentials of Pediatric Nursing, 6th e, 2001, P. 1301.
Methods
• Preoperative assessment also included:
– Apical K readings;
– Central corneal thickness (CCT).
• Statistical analysis was performed using Friedman’s test
and Spearman’s correlation test. A P value ≤ 0.05 was
considered statistically significant.
Results
•
•
•
•
178 eyes of 135 patients
Mean age of 23.4 years  5.9 (SD) (range 13 to 48)
69.7% male, 30.3% female
Three or more analgesic pills were taken by 28% of
patients
• A correlation was observed between age and
– pain at day 3 (r = 0.191; P = 0.011)
– pain at day 4 (r = 0.215; P = 0.004)
– number of analgesic pills at day 0 (r = -0.149; P = 0.047)
• No correlation between pain scores and
– sex, preoperative apical keratometry or CCT readings.
Results
Mean postoperative pain
5
P < 0.05
Subjective pain
4
3
2.8
Mean
2.1
2
SD
1.4
1
0.7
0.3
0.1
0
-1
Day 0
Day 1
Day 2
Day 3
Day 4
Day 5
Results
Significant pain (grade 4 or 5)
100
Patients (%)
80
60
42.7%
40
23.6%
20
11.8%
2.3%
0.7%
0%
Day 3
Day 4
Day 5
0
Day 0
Day 1
Day 2
Conclusion
• Significant ocular pain is frequent after corneal CXL
for keratoconus.
• The pain decreased progressively from the day of
surgery to the third day, being mild after that.
• Opioid analgesics should be offered to these patients
up to three days after surgery.
• Pain does not seem to correlate to keratometric or
pachymetric preoperative readings.
Thank you!