Pre-Emptive Topical Ketorolac Tromethamine 0.5% for Panretinal Photocoagulation

Purpose: To evaluate the efficacy of topical ketorolac tromethamine 0.5% given pre-emptively a day before, for alleviating pain in patients undergoing panretinal photocoagulation (PRP) treatment. Methods: A controlled single-blinded study was conducted on 33 patients with diabetic retinopathy (DR; severe nonproliferative DR, proliferative DR, or advanced diabetic eye disease) who required PRP treatment in both eyes simultaneously. Each eye of the patients was randomly assigned for ketorolac tromethamine 0.5% eyedrop or placebo. Both eyedrop bottles were randomly labeled. Eyedrops were self-administered by the patients, 4 times a day before the procedure (at 6 am, 12 noon, 6 pm, and 12 midnight) and every 15 min for 1 h (4 times) before the laser. Each patient was subjected to PRP using a Visulas 532s Zeiss device set to spot size 200 μm, time 0.10 s, and ∼600 burns in each eye. The pain score was evaluated immediately after treatment in each eye independently with Scott's visual analog scale (VAS) and the McGill Pain Questionnaire (MPQ). Results: VAS pain score in ketorolac-treated eyes (median 3.0, interquatile range [IQR] ±2.5) was lower than in placebo-treated eyes (median 5.0, IQR ±3.0). Total Pain Rate Index score from MPQ was lower in ketorolac-treated eyes (median 3.0, IQR ±3.0) than in placebo-treated eyes (median 3.0, IQR ±2.5). Both pain score differences are statistically significant with P ˂ 0.05. Conclusion: Topical ketorolac tromethamine 0.5% given pre-emptively a day before is effective in alleviating pain in patients undergoing PRP treatment.