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.

Orbital metastasis of prostatic carcinoma.

This paper describes a man with previously undetected prostatic carcinoma who presented with mild symptoms due to an orbital metastasis. The case is unusual in that the patient was relatively asymptomatic and had 6/7 vision. Carcinoma of the prostate metastatic to the orbit is rare; this is only the 22nd case in the literature.

Traumatic macular hole.

A traumatic macular hole has never been seen immediately after the causal accident. We examined a case of macular hole within half an hour of the injury and photographed it within three hours. We comment on the genesis of traumatic macular edema.

Excimer laser keratectomy: one year results with 100 myopic patients.

We present the refractive and visual results for 100 consecutive patients who underwent excimer laser keratectomy for myopia. Their preoperative myopia averaged from -3.5 D (range: -1.0 to -10.0 D). One year follow-up results were available for 87 patients. There were no sight-threatening complications. At one year, 82% of the patients were within 1 D of emmetropia and 97% were within 2 D. Unaided visual acuity of 20/20 or better was achieved by 55% of the patients, while 90% were 20/40 or better.

Excimer laser keratectomy for the correction of myopia.

We present the preliminary refractive and visual results in 46 sighted eyes that had undergone excimer photorefractive keratectomy. Although our sample size was small and the follow-up relatively limited (3-6 months), a few important conclusions were drawn. The visual and refractive results compare quite favorably to the preliminary results with radial keratotomy. Thirty-four of 46 patients (74%) were within 1 D of emmetropia; and 45 (98%) were within 2 D at the end of the follow-up period. Forty-four patients (96%) achieved at least 20/40 vision, with more than half achieving 20/20 or better. We encountered no significant vision threatening complications. Twenty of 46 patients (43%) complained of night vision disturbances, but symptoms improved in all patients by 6 months. The majority of patients developed trace epithelial haze; however, corneal haze did not produce reductions in visual acuity. Though the preliminary results of our study of the safety and efficacy of excimer photorefractive keratectomy are promising, further study of long-term vision stability and corneal clarity is clearly needed.