Efficacy of Topical Nepafenac Versus Nepafenac With Perioperative Cyclopentolate for Pain Management After Photorefractive Keratectomy: A Comparative Clinical Evaluation

Purpose: To compare the efficacy of topical nepafenac alone versus nepafenac combined with cyclopentolate for pain management after photorefractive keratectomy (PRK) through a comprehensive evaluation of pain intensity, stinging, tearing, light sensitivity, analgesic use, and sleep disturbance. Methods: This was a retrospective comparative study using data from a randomized controlled trial registry. A total of 160 patients undergoing PRK were analyzed. Patients were randomized to receive a standard nepafenac regimen either alone or with the addition of perioperative cyclopentolate 1%. Pain, stinging, tearing, and light sensitivity were rated on a visual analog scale (0 to 10) twice daily for 5 postoperative days. Sleep disturbance and analgesic use were also recorded. Results: The nepafenac-only group reported significantly lower pain score means over the 5 days compared to the nepafenac + cyclopentolate group (3.48 ± 2.25 vs 5.42 ± 3.20, P < .001). Secondary outcomes also favored the nepafenac-only group with lower reported levels of stinging sensation (1.72 ± 1.88 vs 5.86 ± 3.36, P < .001), tearing (4.43 ± 3.32 vs 5.45 ± 3.60, P < .001), and light sensitivity (3.75 ± 3.32 vs. 4.47 ± 3.60, P < .001). Moreover, sleep disturbance was less frequent in the nepafenac-only group during the first two postoperative nights ( P < 0.01). Conclusions: Contrary to theoretical expectations, adding cyclopentolate to nepafenac therapy worsened postoperative pain outcomes after PRK. For optimal pain management, a regimen of nepafenac alone appears superior to the combination therapy approach.