Pain Management Strategies before Pan-Retinal Photocoagulation for Diabetic Retinopathy: A Systematic Review

Area of Science:

• Ophthalmology
• Pharmacology
• Pain Management

Background:

• Diabetic retinopathy (DR) is a leading cause of vision loss.
• Pan-retinal photocoagulation (PRP) is a standard treatment for advanced DR.
• Pain is a significant adverse outcome during PRP, impacting patient tolerance and adherence.

Purpose of the Study:

• To systematically review and consolidate evidence on the efficacy of pain relief medications administered before PRP for DR.
• To identify optimal pharmacological strategies for mitigating pain associated with PRP treatment.

Main Methods:

• Comprehensive literature search of major databases (1993-2023).
• Inclusion of clinical trials comparing pain relief drugs before PRP in DR patients.
• Pain assessment using various scales (VAS, NRS, VRS) and consideration of laser parameters.

Main Results:

• Twenty-two trials were included, evaluating NSAIDs, opioids, benzodiazepines, and lidocaine.
• Nine studies assessed NSAIDs (selective and nonselective).
• Eleven studies investigated lidocaine and other sedatives.

Conclusions:

• Lidocaine (2% transconjunctival, retrobulbar, or peribulbar block) is effective for pain relief.
• Specific NSAIDs, including topical ketorolac (24 hours prior) and oral diclofenac potassium (50 mg prior), demonstrate beneficial pain-reducing effects.
• Combined approaches may offer optimal pain management for PRP in DR patients.