Eyeworld

61 EW REFRACTIVE significant, and all symptoms were statistically significant at 1 hour," Dr. Keil said. From a clinical perspective, Dr. Keil views the results as bol- stering use of an NSAID during the femtosecond LASIK procedure. "I think that in order to make patients more comfortable post-LASIK, they should be using a topical NSAID, and our results show that bromfenac with doing it right there during sur- gery, and will that have any effect?" Dr. Keil enlisted the aid of then-res- ident Nathan Cleaveland, DO, and launched the study. Included in the prospective case series were 120 eyes of 64 patients who were undergoing femtosec- ond LASIK. Investigators tried four different approaches. "We did one drop before and one drop after; one drop before and one placebo after; placebo before and one drop after; and placebo before and placebo after," Dr. Keil said. The idea was to try to tease out when the bromfenac would be best administered. While all measures were better than placebo, investigators found that there was some variability in whether patients did better with one drop or two of the bromfenac. When it came to eye pain, with any use of bromfenac, there were statistically lower discomfort scores than with placebo, Dr. Keil report- ed. "In fact, the majority of those patients were sleeping at the 2-hour time point. We considered that a zero [discomfort score] if they could sleep through this," he said, adding that those who got the placebo were most likely to rate their discomfort at the highest level. "I seemed to get fewer complaints from the patients who got bromfenac," Dr. Keil said. With tearing, use of bromfenac before the procedure was significant- ly better at the 1-hour mark; at the 2-hour mark use before and after had a statistically significant advan- tage, he noted. For foreign body sensation, using the bromfenac before the pro- cedure was statistically significant- ly better than placebo, but at the 2-hour mark using this both before and after was statistically significant, Dr. Keil said. Timing He was surprised to find that the single drop could make a significant difference here. "I thought a couple of drops before and after would make a difference, but just one drop immediately before the procedure—I was a little surprised about that," Dr. Keil said, adding that the results spurred him to start using one drop before the procedure. While he had heard anecdotal reports indicating this, it was nice to have proof. "We concluded that using this before and after was best, followed by just before," he said. In Dr. Keil's practice, they opt to use it before the procedure since this seemed to have a significant effect. "The tearing, photophobia, and foreign body sensation measures were statistically is effective," he said. "It's only one drop, and you can either do it before and after or just one drop before." It's possible that the same will hold true for ketorolac; this was not investigated, but the study could be repeated with this in place of brom- fenac, Dr. Keil said. EW Reference 1. Cleaveland NA, et al. Efficacy and periop- erative timing of bromfenac in the manage- ment of ocular discomfort after femtosecond laser-assisted laser in situ keratomileusis. J Cataract Refract Surg. 2017;43:183–188. Editors' note: Dr. Keil has no financial interests related to this comments. Contact information Keil: keilmich@yahoo.com More continued from page 60 Register Now: www.icoph.org/WOC2018 15,000+ people from over 130 countries 350+ scientific sessions with 46 Subspecialty, 36 National and 4 Supranational Societies participating in the program 1,200+ abstract submissions 200+ exhibit companies OnDemand includes 500+ hours available for additional AMA CMEs August 2017

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