Efficacy of Gabapentinoids in pain resolution after Photorefractive Keratectomy: A Systematic Review and Meta-Analysis

Introduction

Photorefractive Keratectomy (PRK) is a procedure used for the correction of refractive errors. It is specifically preferred in cases of reduced corneal thickness or anterior basement membrane dystrophy. Despite being a viable treatment option, post-operative pain is one of the main concerns of PRK. Studies have shown that gabapentin and pregabalin reduce pain as compared to placebo after PRK. Therefore, we aim to conduct a meta-analysis that studies the efficacy of gabapentinoids after PRK.

Methods

A comprehensive search was done using PubMed/MEDLINE, Scopus, and the Cochrane Library from inception till March 2024 for published randomized controlled trials (RCTs) that included 18 years or older patients of PRK who used gabapentinoids (Pregabalin, Gabapentin) for pain resolution. RevMan (version 5.3) was used to calculate Mean differences (MD) with their 95 % confidence intervals (CI).

Results

A total of 3 RCTs were included after a comprehensive screening. The studies included 312 participants. The mean age of the participants in the intervention group was 27.3 years. Gabapentinoid therapy was associated with no significant improvement in pain reduction on operation day post-PRK (MD = -0.64; 95 % CI, -1.63 to 0.35; p-value = 0.20) or after 24 h of operation (MD = -0.45; 95 % CI, -2.01 to 1.11; p-value = 0.57). No significant benefit in terms of total rescue analgesia use post-PRK was observed (MD = -0.69; 95 % CI, -2.88 to 1.51; p-value = 0.5). However, a statistically significant benefit was observed two days after PRK (MD = -0.66 (95 % CI, -1.27 to -0.05; p-value = 0.03).

Conclusion

Gabapentinoids do not show significant efficacy in pain resolution post-PRK as compared to the placebo.