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.

Outcome of inferior oblique recession with or without vertical rectus recession for unilateral superior oblique paresis.

PURPOSE: To determine the effectiveness of a standard fixed 10 mm inferior oblique (IO) recession with or without vertical rectus recession in visually mature patients with unilateral superior oblique paresis (SOP) and mild to moderate IO overaction. METHODS: The records of 24 patients over 12 years of age who had 10 mm IO recession for SOP, for IO overaction of +1 to +3 (out of maximum +4), with 6+ months of followup were reviewed. Criteria required for a "successful" outcome included: 1. hyperdeviation of 5delta or less in primary position; 2. elimination of any compensatory abnormal head posture; and 3. elimination of diplopia in the central 30 degrees of the binocular visual field. RESULTS: In 16 cases of IO recession alone, 88% were "successful" and in 8 cases who had in addition either contralateral inferior rectus recession or ipsilateral superior rectus recession, 75% were "successful". IO 10 mm recession alone led to an average reduction of 9.1 PD of hypertropia in primary position. CONCLUSION: A standard ungraded 10 mm recession of the IO alone or in combination with vertical rectus muscle recession is an effective weakening procedure with a high success rate for patients with unilateral SOP with mild to moderate IO overaction. In occasional cases of undercorrection, a subsequent IO myectomy is very feasible and effective.

Screening for childhood strabismus by primary care physicians.

OBJECTIVE: To review the clinical classification of strabismus, to describe the timing and method of strabismus screening examinations, and to discuss the principles of treatment. QUALITY OF EVIDENCE: Current literature (1983 to 1995) was searched via MEDLINE using the MeSH headings strabismus, ocular motility disorders, and amblyopia. Articles were selected based on their date of publication, clinical relevance, and availability. Preference was given to more recent articles, articles with large numbers of subjects, and well-designed cohort studies. Official recommendations from academic groups were analyzed. Descriptions of clinical tests and their illustrations are based on classic texts. MAIN FINDINGS: Primary care physicians should screen all low-risk children. High-risk children (low birth weight, family history of strabismus, congenital ocular abnormality, or systemic conditions with vision-threatening ocular manifestations) should be referred to an ophthalmologist for screening. Screening should be performed in the neonatal period, at 6 months, and at 3 years (Grade A recommendation), as well as at 5 to 6 years (Grade B recommendation). Screening examination includes inspection, examining visual acuity, determining pupillary reactions, checking ocular alignment, testing eye movements, and ophthalmoscopy. CONCLUSIONS: Primary care physicians are essential to early detection of strabismus and amblyopia. Early detection can help minimize visual dysfunction, allow for normal development of binocular vision and depth perception, and prevent psychosocial dysfunction.