Prospective 3-arm study on pain and epithelial healing after corneal crosslinking

Purpose:To investigate the effect of 3 regimes on pain and wound healing after corneal crosslinking (CXL).Setting:Tertiary academic referral center, Utrecht, the Netherlands.Design:Prospective cohort study.Methods:Consecutive progressive keratoconus patients who underwent 9 mW/cm ²epithelium-off CXL were included. Patients received a bandage contact lens (n = 20), occlusive patch (n = 20), or antibiotic ointment (n = 20) after treatment. Pain scores and quality of life, measured by the McGill Pain Questionnaire and Visual Analogue Scale (VAS), were analyzed. Epithelial healing after 2 days, correlations between pain and psychological factors that influence pain perception (depression anxiety stress score and pain catastrophizing score), and oral pain medication were evaluated.Results:Sixty eyes of 52 patients were analyzed. On average, patients experienced considerable pain after CXL (median VAS score 6.2, range 0 to 10). The postoperative regimen did not significantly affect pain scores, although the antibiotic ointment group reported a higher VAS score (median VAS score 7.2 vs 6.7 and 6.0; P =.57). Occlusive patching showed a trend to quicker resolution of epithelial defects (85% completely healed vs 65% with lenses and 70% with antibiotic ointment; P =.43). Correlations with pain-modulating psychological factors were weak (R ²< 0.3) and not significant. The use of pain medication corresponded poorly to the prescribed use.Conclusion:This study demonstrated clinical equivalence of 3 regimes in combating postoperative pain after routine CXL. Wound healing appeared quicker in the occlusive patch group and therefore might be the best standard of care after CXL. The clinical tradition of using bandage contact lenses should be reevaluated.