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Postoperative Pain After Corneal Collagen Cross-Linking

Ghanem, Vinícius C. MD, PhD; Ghanem, Ramon C. MD, PhD; de Oliveira, Renan MD

doi: 10.1097/ICO.0b013e31824d6fe3
Clinical Science

Purpose: To evaluate the postoperative pain after corneal collagen cross-linking (CXL).

Methods: This prospective study included 178 consecutive eyes of 135 patients with progressive keratoconus who underwent CXL at Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil. Pain was assessed postoperatively using the need for analgesia with 30 mg of codeine (Tylex) and by the patients' subjective evaluation on the Wong-Baker FACES Pain Rating Scale at the end of each day until postoperative day (PO) 5. Correlation of postoperative pain with maximum keratometric reading and central corneal thickness, which were assessed preoperatively, was investigated.

Results: Mean patient age was 23.38 ± 5.86 years. Mean (±SD) patient-scored pain decreased significantly (P < 0.05) from 2.78 (±1.68) on the day of surgery (immediate postoperative period, iPO) to 0.12 (±0.46) on PO5. The mean number of codeine pills was 0.94, 0.72, and 0.28 at iPO, PO1, and PO2, respectively, showing a significant decrease at each time point. Statistical analysis showed significant (P < 0.05) correlation between age and pain at PO3 and PO4 (the younger the patients the greater the pain) and between age and the number of codeine pills on iPO. There was no significant correlation between mean overall pain and preoperative apical keratometry (P = 0.546) and pachymetry (P = 0.072) readings.

Conclusions: CXL postoperative pain can be intense, especially in the first 3 days, even with an aggressive pain control regimen; however, pain and the need for analgesia decreased significantly on each consecutive day. Pain was significantly correlated with the patient's age.

*Cornea Department, Sadalla Amin Ghanem Eye Hospital, Joinville, Brazil

Department of Ophthalmology, University of São Paulo (USP), São Paulo, Brazil

Catholic University of Paraná (PUC), Curitiba, Brazil.

Reprints: Vinícius C. Ghanem, Sadalla Amin Ghanem Eye Hospital, Rua Abdon Batista 172, Joinville, SC 89201, Brazil (e-mail:

The authors state that they have no financial or conflicts of interest to disclose.

Received July 6, 2011

Accepted January 27, 2012

Copyright © 2013 Wolters Kluwer Health, Inc. All rights reserved.