Topical pain control for corneal abrasions: A systematic review and meta-analysis.

OBJECTIVES: Corneal abrasions are common ophthalmic presentations to emergency departments. Among emergency physicians and ophthalmologists, there are highly variable practice patterns with regard to management of resultant pain and discomfort. The goal of this study was to review and analyze the efficacy and safety of topical pain therapies for corneal abrasions, including topical anesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs), cycloplegics, steroids, pressure patching, and the use of a bandage contact lens (BCL). METHODS: The review followed the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines. The protocol was established a priori and published on PROSPERO (CRD42020201288). MEDLINE, EMBASE, CENTRAL, and Web of Science were searched until December 31, 2020. Primary studies comparing topical pain therapies to another therapy or control were included. Primary outcomes included percentage of corneal abrasions healed at 24, 48, and 72 hours, as well as pain control at 24 and 48 hours. Secondary outcomes included use of oral analgesia and incidence of complications. Risk of bias was assessed using validated tools. Quality of evidence was assessed using the GRADE methodology. RESULTS: Overall, 33 studies (31 randomized controlled trials [RCTs], two cohort studies) comprising 4,167 patients with corneal abrasions were analyzed. Only the data for topical NSAIDs were of adequate evidence from which to draw conclusions; topical NSAIDs demonstrated significantly reduced pain scores at 24 hours (standardized mean differences [SMD] -0.69, 95% CI = -0.98 to -0.41) and 48 hours (SMD = -0.56, 95% CI = -1.02 to -0.10) as well as 53% (95% CI = 34% to 67%) lower oral analgesia use compared to control. Based on available data, topical anesthetics, cycloplegics, patching, and the use of a BCL did not result in any significant difference in pain scores or use of oral analgesia, while no studies examined topical steroids. No interventions resulted in healing delays or significantly higher rates of complications compared to controls. CONCLUSIONS: There was strong evidence to support that topical NSAIDs reduce pain associated with corneal abrasions in the first 48 hours and the need for oral analgesia. The existing evidence was insufficient to support or refute the use of topical anesthetics, cycloplegics, steroids, or BCL for pain control in corneal abrasions. Pressure patching was ineffective at pain reduction and may increase the risk of complications. Delays in healing or other complications were not significantly different between any intervention or control for simple, uncomplicated corneal abrasions; however, larger RCTs are required to identify any differences in rare complications.

Design and Validation of a Training Simulator for Laser Capsulotomy, Peripheral Iridotomy, and Retinopexy.

BACKGROUND AND OBJECTIVES: Ophthalmology trainees commonly learn laser procedures on live patients. A simulator for learning peripheral iridotomy (PI), posterior capsulotomy, and retinopexy may improve patient outcomes. MATERIALS AND METHODS: A model eye with artificial tissues was designed. The tissues reacted to laser similarly to human tissues. Inexperienced (n = 6; first- to third-year residents) and experienced (n = 7; fourth- to fifth-year residents and staff) ophthalmic personal were compared on performance of the above laser procedures. RESULTS: The inexperienced group required more shots (P = .04) and caused more lens markings (P = .04) during capsulotomy and had more incomplete retinopexy results (P = .04) than the experienced group. The groups did not differ in total shots for PI, average power for retinopexy, or the total time required for any of the procedures. CONCLUSION: Our model effectively simulates common ophthalmic laser procedures and is practical for the training of ophthalmology residents. [Ophthalmic Surg Lasers Imaging Retina. 2017;48:56-61.].

Comparison of retinal nerve fibre layer measurements from time domain and spectral domain optical coherence tomography systems.

OBJECTIVE: To compare retinal nerve fibre layer (RNFL) thickness measurements acquired using spectral domain (SD) and time domain (TD) optical coherence tomography (OCT) systems. STUDY DESIGN: Prospective clinical study. PARTICIPANTS: Twenty eyes of 20 healthy volunteers. METHODS: All patients underwent 3 sets of circular OCT scans around the optic disc using both a TD OCT system, and a new SD OCT system. RNFL thickness measures within each of 4 quadrants, as well as overall mean RNFL thickness, were compared. Bland-Altman plots were also used to assess agreement. RESULTS: Using the RTVue-100, RNFL measurements in the superior quadrant were, on average, 20 microm greater than those obtained from the Stratus (151.8 microm vs 131.7 microm, p< 0.0001). RNFL measures within other quadrants and overall mean RNFL thickness were not significantly different between systems. Bland-Altman plots indicated large differences between Stratus and RTVue-100 for all variables, with 95% limits of agreement spanning clinically important ranges of >50 microm for all RNFL variables. CONCLUSIONS: Significant differences exist between RNFL measurements obtained from the TD and SD OCT systems used in this study. These related, but distinct, technologies are not interchangeable. Further studies will be required to allow for appropriate clinical use of new SD OCT systems.