Analgesic efficacy of 7 different topical NSAIDs in panretinal photocoagulation-associated pain

To investigate the effects of different topical non-steroidal anti-inflammatory drugs (NSAIDs) and demographic characteristics on pain perception associated with panretinal photocoagulation.

Before panretinal photocoagulation, patients received one of seven topical NSAIDs, while the control group received artificial tears. Following panretinal photocoagulation, subjective pain was assessed using the visual analogue scale. The impact of demographic factors and NSAID type on visual analogue scale scores was statistically analysed. Demographic data were compared using the Mann-Whitney U test and NSAID groups with one-way ANOVA.

The study included 270 eyes from 270 patients. No significant differences were observed among NSAID groups regarding age, gender, diabetes duration, diabetic retinopathy type, number of intravitreal injections, panretinal photocoagulation sessions, or photocoagulation energy. In all participants, pain perception was higher in females (p < 0.001), patients aged ≤ 60 years (p < 0.001), and those with proliferative diabetic retinopathy (p < 0.001). Bromfenac (p < 0.001), indomethacin (p < 0.001), nepafenac 0.3% (p = 0.002), and diclofenac (p = 0.029) significantly reduced pain, whereas ketorolac trometamol, nepafenac 0.1%, and flurbiprofen did not. Among the effective NSAIDs, nepafenac 0.3% and diclofenac were ineffective in males, while diclofenac showed no efficacy in patients over 60 years of age or those with proliferative diabetic retinopathy. No NSAID demonstrated a significant effect in non-proliferative diabetic retinopathy patients.

Bromfenac and indomethacin demonstrate consistent analgesic efficacy in nearly all patients with panretinal photocoagulation-related pain, while nepafenac 0.3% and diclofenac are effective in a majority of cases. However, heightened panretinal photocoagulation-related pain in females, patients aged ≤ 60 years and those with proliferative diabetic retinopathy may necessitate careful consideration in these populations.