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Diclofenac and ketorolac in the treatment of pain after photorefractive keratectomy.

BACKGROUND
Photorefractive keratectomy (PRK) can produce significant ocular pain. Topical diclofenac, a non-steroidal anti-inflammatory drug (NSAID), is effective in the reduction of this pain. This study compares a second NSAID, ketorolac, to diclofenac.


METHODS
This prospective matched-control study involved 102 eyes of 102 patients. Prior to PRK, patients were randomly assigned to receive ketorolac or diclofenac drops. At the first postoperative visit, a standardized questionnaire was used to assess the patient's average and peak levels of discomfort. In addition, the quantities of acetaminophen and codeine consumed were recorded.


RESULTS
The overall level of discomfort was 1.53 +/- 0.64 for diclofenac and 1.88 +/- 0.55 for ketorolac (scale: 0 to 4) (P = 0.004). The diclofenac group reported a peak discomfort level of 2.0 +/- 0.75 and the ketorolac group reported 2.3 +/- 0.62 (P > 0.05). The diclofenac group consumed 2000 +/- 1150 mg of acetaminophen and 92 +/- 54 mg of codeine whereas the ketorolac group consumed 2150 +/- 940 of acetaminophen and 98 +/- 50 mg of codeine (P > 0.05).


CONCLUSIONS
The differences in levels of peak discomfort, acetaminophen ingestion, and codeine ingestion, were not statistically significant. As compared to ketorolac, diclofenac resulted in a statistically significant lower mean overall discomfort.