PMID- 28516471 OWN - NLM STAT- MEDLINE DCOM- 20170809 LR - 20230328 IS - 1469-493X (Electronic) IS - 1361-6137 (Linking) VI - 5 IP - 5 DP - 2017 May 18 TI - Topical non-steroidal anti-inflammatory drugs for analgesia in traumatic corneal abrasions. PG - CD009781 LID - 10.1002/14651858.CD009781.pub2 [doi] LID - CD009781 AB - BACKGROUND: Traumatic corneal abrasions are relatively common and there is a lack of consensus about analgesia in their management. It is therefore important to document the clinical efficacy and safety profile of topical ophthalmic non-steroidal anti-inflammatory drugs (NSAIDs) in the management of traumatic corneal abrasions. OBJECTIVES: To identify and evaluate all randomised controlled trials (RCTs) comparing the use of topical NSAIDs with placebo or any alternative analgesic interventions in adults with traumatic corneal abrasions (including corneal abrasions arising from foreign body removal), to reduce pain, and its effects on healing time. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (which contains the Cochrane Eyes and Vision Trials Register) (2017, Issue 2), MEDLINE Ovid (1946 to 30 March 2017), Embase Ovid (1947 to 30 March 2017), LILACS (Latin American and Caribbean Health Sciences Literature Database) (1982 to 30 March 2017), OpenGrey (System for Information on Grey Literature in Europe) (www.opengrey.eu/); searched 30 March 2017, ZETOC (1993 to 30 March 2017), the ISRCTN registry (www.isrctn.com/editAdvancedSearch); searched 30 March 2017, ClinicalTrials.gov (www.clinicaltrials.gov); searched 30 March 2017 and the WHO International Clinical Trials Registry Platform (ICTRP) (www.who.int/ictrp/search/en); searched 30 March 2017. We did not use any date or language restrictions in the electronic searches for trials.We checked the reference lists of identified trials to search for further potentially relevant studies. SELECTION CRITERIA: RCTs comparing topical NSAIDs to placebo or any alternative analgesic interventions in adults with traumatic corneal abrasions. DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and assessed risks of bias in the included studies. We rated the certainty of the evidence using GRADE. MAIN RESULTS: We included nine studies that met the inclusion criteria, reporting data on 637 participants.The studies took place in the UK, USA, Israel, Italy, France and Portugal. These studies compared five types of topical NSAIDs (0.1% indomethacin, 0.03% flurbiprofen, 0.5% ketorolac, 1% indomethacin, 0.1% diclofenac) to control (consisting of standard care and in four studies used placebo eye drops). Overall, the studies were at an unclear or high risk of bias (particularly selection and reporting bias). None of the included studies reported the primary outcome measures of this review, namely participant-reported pain intensity reduction of 30% or more or 50% or more at 24 hours. Four trials, that included data on 481 participants receiving NSAIDs or control (placebo/standard care), reported on the use of 'rescue' analgesia at 24 hours as a proxy measure of pain control. Topical NSAIDs were associated with a reduction in the need for oral analgesia compared with control (risk ratio (RR) 0.46, 95% confidence interval (CI) 0.34 to 0.61; low-certainty evidence). Approximately 4 out of 10 people in the control group used rescue analgesia at 24 hours. No data were available on the use of analgesia at 48 or 72 hours.One trial (28 participants) reported on the proportion of abrasions healed after 24 and 48 hours. These outcomes were similar in both arms of the trial. (at 24 hours RR 1.00 (0.81 to 1.23); at 48 hours RR 1.00 (0.88 to 1.14); low-certainty evidence). In the control group nine out of 10 abrasions were healed within 24 hours and all were healed by 48 hours. Complications of corneal abrasions were reported in 6 studies (609 participants) and were infrequently reported (4 complications, 1 in NSAID groups (recurrent corneal erosion) and 3 in control groups (2 recurrent corneal erosions and 1 corneal abscess), very low-certainty evidence). Possible drug-related adverse events (AEs) were reported in two trials (163 participants), with the number of adverse events low (4 AEs, 3 in NSAID group, including discomfort/photophobia on instillation, conjunctival hyperaemia and urticaria, and 1 in the control group, corneal abscess) very low-certainty evidence. AUTHORS' CONCLUSIONS: The findings of the included studies do not provide strong evidence to support the use of topical NSAIDs in traumatic corneal abrasions. This is important, since NSAIDs are associated with a higher cost compared to oral analgesics. None of the trials addressed our primary outcome measure of participant-reported pain intensity reduction of 30% or more or 50% or more at 24 hours. FAU - Wakai, Abel AU - Wakai A AD - Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Ireland. FAU - Lawrenson, John G AU - Lawrenson JG AD - Applied Vision Research Centre, School of Health Sciences, City University of London, Northampton Square, London, UK, EC1V 0HB. FAU - Lawrenson, Annali L AU - Lawrenson AL AD - Emergency Department, Epsom General Hospital, Dorking Road, Epsom, Surrey, UK, KT18 7EG. FAU - Wang, Yongjun AU - Wang Y AD - Schulich School of Medicine & Dentistry, Western University, Kresge Building, Rm. K1, London, ON, Canada. FAU - Brown, Michael D AU - Brown MD AD - Department of Emergency Medicine, Michigan State University College of Human Medicine, 100 Michigan NE, Grand Rapids, MI, USA, 49503. FAU - Quirke, Michael AU - Quirke M AD - Emergency Care Research Unit (ECRU), Division of Population Health Sciences (PHS), Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Ireland. FAU - Ghandour, Omar AU - Ghandour O AD - School of Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Ireland. FAU - McCormick, Ryan AU - McCormick R AD - School of Medicine, Royal College of Surgeons in Ireland (RCSI), 123 St. Stephen's Green, Dublin 2, Ireland. FAU - Walsh, Cathal D AU - Walsh CD AD - Health Research Institute (HRI) and MACSI, Department of Mathematics and Statistics, University of Limerick, Ireland. FAU - Amayem, Ahmed AU - Amayem A AD - Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada. FAU - Lang, Eddy AU - Lang E AD - Department of Emergency Medicine, University of Calgary, 2015 42 Ave SW, Calgary, Alberta, Canada, T2T 2M8. FAU - Harrison, Nick AU - Harrison N AD - Beaumont Health Emergency Medicine Residency, Beaumont Hospital, Royal Oak, Michigan, USA, 48067. LA - eng PT - Journal Article PT - Meta-Analysis PT - Review PT - Systematic Review DEP - 20170518 PL - England TA - Cochrane Database Syst Rev JT - The Cochrane database of systematic reviews JID - 100909747 RN - 0 (Anti-Inflammatory Agents, Non-Steroidal) RN - 144O8QL0L1 (Diclofenac) RN - 5GRO578KLP (Flurbiprofen) RN - XXE1CET956 (Indomethacin) RN - YZI5105V0L (Ketorolac) SB - IM UOF - doi: 10.1002/14651858.CD009781 MH - Administration, Topical MH - Anti-Inflammatory Agents, Non-Steroidal/*administration & dosage/adverse effects MH - Corneal Injuries/complications/*drug therapy MH - Diclofenac/administration & dosage MH - Flurbiprofen/administration & dosage MH - Humans MH - Indomethacin/administration & dosage MH - Ketorolac/administration & dosage MH - Pain Measurement MH - Randomized Controlled Trials as Topic MH - Wound Healing PMC - PMC6481688 COIS- Abel Wakai: none known
 John Lawrenson: none known
 Annali Lawrenson: none known
 Yongjun Wang: none known
 Michael Brown: none known
 Michael Quirke: none known
 Omar Ghandour: none known
 Ryan McCormick: none known
 Cathal Walsh: none known
 Ahmed Amayem: none known
 Eddy Lang: none known
 Nick Harrison: none known EDAT- 2017/05/19 06:00 MHDA- 2017/08/10 06:00 PMCR- 2018/05/18 CRDT- 2017/05/19 06:00 PHST- 2017/05/19 06:00 [pubmed] PHST- 2017/08/10 06:00 [medline] PHST- 2017/05/19 06:00 [entrez] PHST- 2018/05/18 00:00 [pmc-release] AID - CD009781.pub2 [pii] AID - 10.1002/14651858.CD009781.pub2 [doi] PST - epublish SO - Cochrane Database Syst Rev. 2017 May 18;5(5):CD009781. doi: 10.1002/14651858.CD009781.pub2.