Ketorolac Used To Control Pain After Photorefractive Keratectomy

In their study on pain management after photorefractive keratectomy (PRK), Shetty et al.1 found that a bandage silicone hydrogel contact lens soaked in preservative-free ketorolac 0.45% solution and used as a drug depot reduced pain after transepithelial PRK in patients who also received ketorolac 0.45% eyedrops 2 times on the day of surgery. Our first question is when were the 2 eyedrops applied? In addition, in Table 1, the authors showed pain scores at the immediate postoperative period and 3 days postoperatively. However, the exact time used for determining the immediate postoperative period is not indicated. As Sobas et al.2 have shown, patients report pain after PRK as soon as 30 minutes after the procedure, with the peak intensity being approximately 24 hours postoperatively. In their group of 32 patients who received a cold patch for 15 minutes, topical cold dexamethasone, and oral alprazolam (and topical cyclopentolate and oral tramadol/paracetamol as rescue medications for unbearable pain), Sobas et al.2 found great variability among patients in the intensity of pain experienced during the early postoperative period. However, there was a tendency for the pain level to increase during the first 9 hours postoperatively, reaching its peak at 24 hours and then being mostly stable until 36 hours, when it started to diminish until 96 hours postoperatively. Therefore, regarding the study by Shetty et al.,1 it is critical to know how much time had elapsed at the time of the evaluation of the immediate pain score and also whether the evaluation was performed at the same time postoperatively in all cases. It would also be important to know the pain level 24 hours postoperatively. Finally, the authors mentioned that topical moxifloxacin 0.5% eyedrops and lubricating eyedrops (sodium hyaluronate 0.1%) were administered. Did the patients receive topical corticosteroids or oral analgesics?