The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy

Eliya Levinger; Nir Gomel; Ami Hirsh; Maya Tenne; Asaf Achiron; Nadav Levinger; Shmuel Levinger; Nadav Shemesh; Adi Abulafia; Michael Mimouni; Nir Sorkin

doi:10.1177/25158414251349340

The added effect of preoperative nepafenac on pain and discomfort following alcohol-assisted photorefractive keratectomy

Ther Adv Ophthalmol. 2025 Jun 24:17:25158414251349340. doi: 10.1177/25158414251349340. eCollection 2025 Jan-Dec.

Authors

Eliya Levinger¹, Nir Gomel², Ami Hirsh³, Maya Tenne⁴, Asaf Achiron^{5

3}, Nadav Levinger^{3

6}, Shmuel Levinger³, Nadav Shemesh⁴, Adi Abulafia⁶, Michael Mimouni⁷, Nir Sorkin⁵

Affiliations

¹ Department of Ophthalmology, Tel-Aviv Medical Center, Weizzman 6, Tel Aviv 6423906 Israel Enaim Medical Center, Tel-Aviv, Israel.
² Department of Ophthalmology, Tel-Aviv Medical Center, Weizzman 6, Tel Aviv 6423906 Israel.
³ Enaim Medical Center, Tel-Aviv, Israel.
⁴ The Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
⁵ Department of Ophthalmology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
⁶ Department of Ophthalmology, Shaare Zedek Medical Center and the Hebrew University-Hadassah Medical School, Jerusalem, Israel.
⁷ Department of Ophthalmology, Rambam Health Care Campus affiliated with the Bruce and Ruth Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.

Abstract

Purpose: To evaluate the effect of preoperative nepafenac on pain following alcohol-assisted photorefractive keratectomy (PRK).

Settings: Tel-Aviv Sourasky Medical Center-a tertiary medical center.

Design: Observational case-series.

Methods: Setting: Refractive center. Study Population: 205 PRK patients grouped randomly into five according to pain-management protocols: (1) paracetamol/ibuprofen (Parac-Ibupr group, n = 39), (2) high-dose oxycodone/naloxone only (Oxy-only group, n = 45), (3) oxycodone/naloxone and postoperative 0.1%-nepafenac (Oxy-Nep group, n = 36), (4) oxycodone/naloxone and preoperative and postoperative 0.1%-nepafenac (Nep-Oxy-Nep group, n = 42), and (5) preoperative and postoperative 0.1%-nepafenac only (Nep-only group, n = 43). Preoperative nepafenac was administered three times daily for 2 days. Main Outcome Measures: Mean and maximal pain levels (postop days 1-5), duration of tearing/photophobia, number of pain tablets taken, uncorrected visual acuity (UCVA), side effects and epithelial healing delay.

Results: Mean pain scores differed significantly between groups (p < 0.001)-lowest in groups receiving preop nepafenac (Nep-only: 1.8 ± 1.6, Nep-Oxy-Nep: 2.3 ± 1.5) compared to the Oxy-Nep (3.2 ± 1.9), Oxy-only (3.8 ± 1.7), and Parac-Ibupr (4.8 ± 1.6) groups. Similar findings were observed with maximal pain scores. Total number of pain tablets taken was lowest in the Nep-only group. Duration of photophobia was shortest in groups receiving preoperative nepafenac (p < 0.001). Duration of tearing was longest in the Parac-Ibupr group (p < 0.001). Nausea/vomiting occurred in 20% of the Oxy-only group (p < 0.001). There were four cases of delayed epithelial healing-all in groups not treated with nepafenac. One-month UCVA did not differ between groups. No additional independent factors were found to be associated with pain except age.

Conclusion: Adding preoperative nepafenac significantly reduced pain and photophobia with complete epithelial healing. Addition of oral opiates to nepafenac treatment had little analgetic benefit.

Keywords: NSAID; PRK; analgetic; nepafenac; nevanac; non-steroidal anti-inflammatory drug; pain; photorefractive keratectomy.