A prospective three-armed study on pain and epithelial healing after corneal crosslinking

Purpose To investigate the effect of three different regimes on post‐operative pain and wound healing after corneal crosslinking (CXL). Methods This single‐center prospective cohort study included patients with progressive keratoconus who were scheduled for CXL. Patients received either a bandage contact lens (n = 20), occlusive patching (n = 20) or antibiotic ointment only (n = 20) after treatment. Primary outcome measure was postoperative pain and quality of life, measured by the McGill Pain Questionnaire and Visual Analogue Score (VAS). Secondary outcomes were epithelial healing after two days, correlations between pain and psychological factors that influence the perception of pain (Depression Anxiety Stress Score & Pain Catastrophizing Score), and the consumption of oral pain medication. Results Sixty consecutive treated eyes of 52 patients were analyzed. On average, patients experienced considerable pain after CXL (mean VAS 5.9 ± 2.6). The post‐operative regimen did not significantly affect the amount of experienced pain, though the antibiotic ointment group reported a higher VAS (VAS 6.4 vs 5.7 & 5.6; p = 0.571). Occlusive patching showed a trend to quicker resolution of the epithelial defect (85% completely healed vs 65% with lenses and 70% with antibiotic ointment; p = 0.434). Correlations with potential pain‐modulating psychological factors were weak (R2 < 0.3) and not significant. The actual use of pain medication corresponded poorly to the prescribed use and was not correlated with differences in pain perception. No adverse events occurred. Conclusion Our study demonstrated a clinical equivalence of the three regimes in combating the post‐operative pain experienced after routine epi‐off CXL. Wound healing appeared quicker in the occlusive patch group. Since contact lenses incur a potential risk of keratitis, we argue that the clinical tradition of using bandage contact lenses after CXL should be re‐evaluated. Occlusive patching is proposed as the new standard of care.