Analgesic eVect of topical sodium diclofenac 0.1% drops during retinal laser photocoagulation

Aims—To evaluate the analgesic eVect of topical sodium diclofenac 0.1% during retinal laser photocoagulation. Methods—87 patients, 45 with proliferative diabetic retinopathy treated with two sessions of panretinal photocoagulation (group A), and 42 patients with nonproliferative diabetic retinopathy who underwent grid treatment of the posterior pole (19 bilaterally) (group B). Sodium diclofenac 0.1% or sodium chloride 0.9% drops were topically applied 30–135 minutes before laser treatment in a masked fashion. Patients who had two sessions were given the alternate drug in the second one. Pain level was evaluated immediately after laser treatment with the visual analogue scale (VAS). The results were statistically analysed. Results—Patients in group A reported pain in 85/90 sessions (94%). The average pain level was 44.2% with sodium diclofenac 0.1% drops and 53.1% with sodium chloride 0.9% drops (p = 0.011 by paired t test). Patients in group B reported pain in only 16/60 sessions (26.7%), and the pain level ranged from 10% to 60% regardless of the kind of drops used. There was no correlation in either group between level of pain and time interval from application of the drops to laser treatment (30–135 minutes) or average energy level used (100–500 mW). Conclusion—Sodium diclofenac 0.1% is useful for pain reduction and should be applied before panretinal photocoagulation. (Br J Ophthalmol 2000;84:135–137) Non-steroidal anti-inflammatory drugs (NSAIDs) are a group of compounds used systemically or locally as analgesic, antipyretic, and anti-inflammatory agents. Sodium diclofenac 0.1% (Voltaren Ophtha), which belongs to the phenylacetic acid chemical class, is widely used today as an analgesic for the anterior segment of the eye. It has been shown to decrease normal human corneal sensitivity, 2 and to have an impressive eVect in patients with corneal abrasions. 4 It also reduces discomfort after cataract surgery, radial keratotomy, and excimer photorefractive keratectomy. 8 In one study of its application in the posterior segment, sodium diclofenac 0.1% was proved eVective in patients undergoing scleral buckling and vitrectomy. In the present study, we evaluated the analgesic eVect of sodium diclofenac 0.1% drops in retinal laser treatment. Patients and methods A prospective, double masked, crossover, randomised, clinical design was used. The study population included 87 patients, 45 (26 male, 19 female) with proliferative diabetic retinopathy treated with panretinal photocoagulation (PRP) (group A) and 42 (22 male, 20 female) with non-proliferative diabetic retinopathy and clinically significant macular oedema (group B) who received grid treatment of the posterior pole. None of the patients had undergone previous laser therapy. All patients in group A received two laser sessions (90 sessions); in group B, 23 were treated unilaterally (one session) and 19 bilaterally (one session per eye) (total 60). Forty one patients in group A and 13 in group B were taking 100 mg salicylic acid regularly. The sodium diclofenac 0.1% was preserved in thiomersal 0.04 mg and stored in an identical bottle as the sodium chloride 0.9%; the masked bottles were marked 1 and 2, respectively. For each patient, just before the first laser session, the first researcher selected one of the bottles from a table at random and applied the drops. For the second laser session (that is, all of group A and 19/42 of group B), patients initially given drops from bottle 1 (sodium diclofenac 0.1%) were treated with bottle 2 (sodium chloride 0.9%) and vice versa. (Both sodium diclofenac 0.1% and sodium chloride 0.9% are odourless and do not sting.) In addition, drops of tropicamide 0.5% and phenylephrine hydrochloride 10% were given to dilate the pupils, one drop of benoxinate hydrochloride 0.4% was applied just before laser treatment as a local anaesthetic. No anaesthetic injection was given. The second researcher (who applied the laser treatment with a contact lens) was masked to the drops given. A double frequency YAG laser was used: wavelength 532 nm, spot size 200 μm, exposure time 0.1 ms, and energy level 100–500 mW; the number of applications ranged from 20 to 1000. Laser treatment was performed by the second researcher 30–135 minutes after administration of the analgesic agent. Pain sensation was evaluated immediately after treatment by the third researcher, who was also masked to the drops given, with Scott’s visual analogue scale (VAS). The VAS consists of a 10 cm scale along which are Br J Ophthalmol 2000;84:135–137 135 Department of Ophthalmology, Rabin Medical Center, Beilinson Campus, Petah Tiqva and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel D Weinberger Y Ron H Lichter I Rosenblat R Axer-Siegel Y Yassur