Better Pain Management Protocol Published

This week saw the publication of ELZA’s better pain management protocol in the Journal of Clinical Medicine, and represents a significant advance in the way pain is managed in the first few days after epi-off CXL and TransPRK.

The reason patients need to take painkiller eyedrops after these procedures is the fact that both involve the removal of some of the epithelial cells at the top of the cornea before the stroma – the layer beneath – is treated. The epithelial cells regrow in the days afterward, but during this period, unless patients take their prescribed pain management eyedrops, they can experience pain and inflammation. Nobody wants patients to be in pain, so we give patients the best painkilling eyedrops available.

If you have a headache, you might take an ibuprofen tablet to take the pain away. Ibuprofen is an example of a non-steroidal anti-inflammatory drug (NSAID) – it reduces the inflammation that is causing the pain. These drugs are great painkillers when taken as a pill, and it’s also a great painkiller when it is administered as an eyedrop to your eyes. However, there is a reason many refractive surgeons do not offer NSAID eyedrops after surgery: side effects. They can slow the speed at which the epithelial cells regrow, and in very rare occasions, can cause the formation of severe corneal ulcers known as corneal melts.

Two questions were asked by Prof. Hafezi and his co-authors. The first was: why? The second was, can we do anything about it? If we can safely use NSAIDs in the first few days after surgery, then we can give patients the best quality of pain relief possible.

To answer the first question, we had to look at how NSAID drugs work. The act by blocking an enzyme called cyclooxygenase, which converts molecules found in the membrane of every cell, called phospholipids, into molecules that cause inflammation, and therefore pain. However, this means that more phospholipids go down a different route: the 5-lipoxygenase pathway, and this results in the upregulation of enzymes – matrix metalloproteinases – that digest protein, which explains the potential risk of melting.

This reveals the answer to the second question: can we do something about it? Ideally, you would use a topical 5-lipoxygenase inhibitor at the same time as a NSAID – but no such drug exists. However, there is a class of drug that can inhibit both pathways: steroids. Empirically, combining NSAIDs with steroids should mean we can get great NSAID pain relief, without the NSAID drawbacks. This is what Jerry Tan and Shady Awwad proposed, and for many years, they have been using this regimen in their clinics to give patients better pain management after TransPRK or epi-off CXL surgery. What the ELZA Institute did was formally examine the outcomes of every patient that had received this pain protocol over a 7 year period, just to make sure that there was no indication of delayed epithelial cell healing, or worse, corneal melting, with this approach. And in 877 patients, that’s exactly what we found.

 

Click here to read the paper:

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Augeninstitut ELZA
4.7
Based on 104 reviews
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Serena Fazio
Serena Fazio
11:15 06 Mar 22
I have been to the ELZA clinic to have surgery for my miopy, as my eyes were rejecting the contacts and I was tired of... wearing glasses. From the first preliminary visit, to the actual surgery and post-surgery care Dr. Hafezi and all his collaborators have been extremely professional, considerate and helpful. All the steps of the (very short!) surgery were thoroughly explained to me in order to be as calm as possible, together with the medication plan and precautions to be aware of so that my eyes could heal in the best way possible. By following their exact instructions, the healing process has been very successful and smooth, and after about one week I was able to see perfectly. I absolutely recommend this team and their expertise!read more
Robin A
Robin A
11:43 16 Feb 22
Top experts and professional team. Highly recommended
Thunder Shiviah
Thunder Shiviah
14:05 23 Nov 21
After some research on local options I decided to go with ELZA since it stood out as the best. The operation and the... post-operation recovery went extremely smooth (something I was worried about with PRK). Now my vision is much better than I had hoped and I have no side effects such as dry eye or night vision problems. Thank you!read more
Squitieri Elias
Squitieri Elias
12:43 08 Sep 21
Die Behandlungen waren bei mir erfolgreich, alle waren sehr nett und haben mein Leben vereinfacht.Danke
Eliane Bossart
Eliane Bossart
13:01 05 Sep 21
Vor einem Jahr war ich einer ganz verzweifelten Situation und total im Stich gelassen. Meine Augen wurden aufgrund... eines ausgeprägten Kerakotonus immer schlechter, ich hatte Angst und war alleine mit meinen Problemen. Zudem vertrug ich die Kontaktlinsen nur noch ganz schlecht und hatte jeden Tag Schmerzen.Professor Hafezi hat mir mit zwei Operationen wieder das auf Grund der Situation mögliche an Lebensqualität zurückgebracht. Es war ein starpaziöses Jahr mit vielen Entbehrungen aber es hat sich gelohnt! Herzlichen Dank fuer die Unterstützung.read more
Gabriela Meyer
Gabriela Meyer
18:32 22 Aug 21
Ich wurde von meiner Optikerin auf Prof. Dr. Dr. Hafezi aufmerksam gemacht. Es war mir vorher nicht bewusst, dass meine... Augenkrankheit (Keratokonus) operativ mittels Cross Linking behandelt und so gestoppt werden kann. Die Beratung und Behandlung war sehr kompetent und ich fühlte mich jederzeit wohl. Die Operation verlief gut und das Ergebnis ist einwandfrei.read more
Naomi
Naomi
11:38 11 Aug 21
Ich bin sehr glücklich, dass ich das Elza Institute gefunden habe. Ich wurde von anderen Augenärzten abgewiesen, da... meine Augen zu kompliziert/schwierig zu behandeln waren. Prof. Dr. Dr. Hafezi konnte mir jedoch helfen und ich bin sehr glücklich und zufrieden mit dem Resultat. Vielen Dank!read more
Till B
Till B
08:30 19 Jul 21
Ich habe eine überaus kompetente Beratung und Behandlung erlebt. Die gesamte Betreuung war sehr freundlich und... professionell. Herzlichen Dank!read more
Thomas S.
Thomas S.
09:37 07 Jul 21
My left eye had to be operated on because of a cataract. As I had an Artiflex lens implanted a few years ago, it had to... be removed first before a modern lens could be implanted to correct the cataract. Prof. Hafezi treated me in an very competent and friendly manner. I am very happy with the result.read more
Selma A. Rahim
Selma A. Rahim
19:45 02 Jul 21
Dr. Hafezi.. the KING OF CXL🤴
Gianluca Ricci
Gianluca Ricci
12:46 10 Apr 21
Great team and service!
rehaneyecare
rehaneyecare
05:36 08 Apr 21
Excellent surgeon
Steven H.A
Steven H.A
16:13 11 Jan 21
Prof. F. Hafezi s expertise is enormous and he has a very pleasant and calm nature which gives the patient... security.Thank youread more
Online Commande
Online Commande
09:19 05 Dec 20
Totally creepy, very arrogant Prof.He just want your money.It may explain, why this Prof. is not in the center of the... city of Zürich and why he has been thrown away from University of Geneva.read more
Elena Churilova
Elena Churilova
10:06 17 Nov 20
At the moment, 3 months have passed since the moment I made laser vision correction in this clinic. and I can say that... I am happy that I chose this particular clinic and Prof. F. Hafezi. The entire staff of the clinic is very friendly, treats patients with sympathy and patience if they are nervous before surgery (my big gratitude to Aida Alili for all support and patience). The doctor Hafezi and other doctors of the clinic are very professional and ready to explain to you as many times as you need. I can only recommend!read more
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Augeninstitut ELZA
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