pattern of pain and analgesic use after collagen crosslinking for progressive keratoconus ramon...

Pattern of Pain and Analgesic use after Collagen Crosslinking for

Progressive KeratoconusRamon 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.

Catarinense Center for Keratoconus Treatment

Purpose

• To evaluate postoperative pain after standard riboflavin- ultraviolet-A corneal collagen crosslinking (CXL)*.

*Riboflavin/UV-A CXL has not been approved by the U.S. FDA.

• 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).

Methods

1Wong DL et al. Wong’s Essentials of Pediatric Nursing, 6th e, 2001, P. 1301.

• 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.

Methods

• 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

Results

P < 0.05

SD

Results

• 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.

Conclusion

Thank you!