Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions
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...
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| creator | Wakai, Abel Lawrenson, John G Lawrenson, Annali L Wang, Yongjun Brown, Michael D Quirke, Michael Ghandour, Omar McCormick, Ryan Walsh, Cathal D Amayem, Ahmed Lang, Eddy Harrison, Nick Wakai, Abel |
| description | 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 o |
| doi_str_mv | 10.1002/14651858.CD009781.pub2 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6481688</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1900129232</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4732-6f4a0fe866edcac1d97e02fd26c074bc8743617d4cbc2a2a06134a805f727d013</originalsourceid><addsrcrecordid>eNqFUctOAyEUJUbj-xfMLN20AkOB2ZhofSYmbnQruWWYipmBCjOa7vwEv9EvkUltU924Au553XAQOiJ4SDCmJ4TxEZEjORxfYFwISYazbkI30G4PDHpkc-2-g_ZifME45wUV22iHyhHhTJBd9PTgZ1ZDnTnvvj4-Y2uCt2V6g2ttGlhX1dA00Powz8rQTWNW-ZBQqKcmWsisy9oAXWJYnWkfnOnFkwDRehcP0FYFdTSHP-c-ery6fBjfDO7ur2_HZ3cDzUROB7xigCsjOTelBk3KQhhMq5JyjQWbaClYzokomZ5oChQwJzkDiUeVoKLEJN9Hpwvf9AtN8jAuLVWrWbANhLnyYNVvxNlnNfVvijNJuJTJ4PjHIPjXzsRWNTZqU9fgjO-iIgXGhBY0p4nKF1QdfIzBVKsYglVfjlqWo5bl9OG98Gh9yZVs2UYinC8I77Y2c6W9fg4p_x_fPynfH9CkTA</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1900129232</pqid></control><display><type>article</type><title>Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions</title><source>MEDLINE</source><source>Cochrane Library</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Wakai, Abel ; Lawrenson, John G ; Lawrenson, Annali L ; Wang, Yongjun ; Brown, Michael D ; Quirke, Michael ; Ghandour, Omar ; McCormick, Ryan ; Walsh, Cathal D ; Amayem, Ahmed ; Lang, Eddy ; Harrison, Nick ; Wakai, Abel</creator><creatorcontrib>Wakai, Abel ; Lawrenson, John G ; Lawrenson, Annali L ; Wang, Yongjun ; Brown, Michael D ; Quirke, Michael ; Ghandour, Omar ; McCormick, Ryan ; Walsh, Cathal D ; Amayem, Ahmed ; Lang, Eddy ; Harrison, Nick ; Wakai, Abel</creatorcontrib><description>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.</description><identifier>ISSN: 1465-1858</identifier><identifier>ISSN: 1469-493X</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD009781.pub2</identifier><identifier>PMID: 28516471</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject><![CDATA[Administration, Topical ; Anti-Inflammatory Agents, Non-Steroidal - administration & dosage ; Anti-Inflammatory Agents, Non-Steroidal - adverse effects ; Anti‐Inflammatory Agents, Non‐Steroidal ; Cornea ; Corneal Injuries ; Corneal Injuries - complications ; Corneal Injuries - drug therapy ; Diclofenac ; Diclofenac - administration & dosage ; Eye injuries ; Eyes & vision ; Flurbiprofen ; Flurbiprofen - administration & dosage ; Humans ; Indomethacin ; Indomethacin - administration & dosage ; Ketorolac ; Ketorolac - administration & dosage ; Medicine General & Introductory Medical Sciences ; Outer eye ; Pain Measurement ; Randomized Controlled Trials as Topic ; Wound Healing]]></subject><ispartof>Cochrane database of systematic reviews, 2017-05, Vol.2017 (5), p.CD009781</ispartof><rights>Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4732-6f4a0fe866edcac1d97e02fd26c074bc8743617d4cbc2a2a06134a805f727d013</citedby><cites>FETCH-LOGICAL-c4732-6f4a0fe866edcac1d97e02fd26c074bc8743617d4cbc2a2a06134a805f727d013</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,780,784,885,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/28516471$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wakai, Abel</creatorcontrib><creatorcontrib>Lawrenson, John G</creatorcontrib><creatorcontrib>Lawrenson, Annali L</creatorcontrib><creatorcontrib>Wang, Yongjun</creatorcontrib><creatorcontrib>Brown, Michael D</creatorcontrib><creatorcontrib>Quirke, Michael</creatorcontrib><creatorcontrib>Ghandour, Omar</creatorcontrib><creatorcontrib>McCormick, Ryan</creatorcontrib><creatorcontrib>Walsh, Cathal D</creatorcontrib><creatorcontrib>Amayem, Ahmed</creatorcontrib><creatorcontrib>Lang, Eddy</creatorcontrib><creatorcontrib>Harrison, Nick</creatorcontrib><creatorcontrib>Wakai, Abel</creatorcontrib><title>Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>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.</description><subject>Administration, Topical</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - administration & dosage</subject><subject>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</subject><subject>Anti‐Inflammatory Agents, Non‐Steroidal</subject><subject>Cornea</subject><subject>Corneal Injuries</subject><subject>Corneal Injuries - complications</subject><subject>Corneal Injuries - drug therapy</subject><subject>Diclofenac</subject><subject>Diclofenac - administration & dosage</subject><subject>Eye injuries</subject><subject>Eyes & vision</subject><subject>Flurbiprofen</subject><subject>Flurbiprofen - administration & dosage</subject><subject>Humans</subject><subject>Indomethacin</subject><subject>Indomethacin - administration & dosage</subject><subject>Ketorolac</subject><subject>Ketorolac - administration & dosage</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Outer eye</subject><subject>Pain Measurement</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Wound Healing</subject><issn>1465-1858</issn><issn>1469-493X</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFUctOAyEUJUbj-xfMLN20AkOB2ZhofSYmbnQruWWYipmBCjOa7vwEv9EvkUltU924Au553XAQOiJ4SDCmJ4TxEZEjORxfYFwISYazbkI30G4PDHpkc-2-g_ZifME45wUV22iHyhHhTJBd9PTgZ1ZDnTnvvj4-Y2uCt2V6g2ttGlhX1dA00Powz8rQTWNW-ZBQqKcmWsisy9oAXWJYnWkfnOnFkwDRehcP0FYFdTSHP-c-ery6fBjfDO7ur2_HZ3cDzUROB7xigCsjOTelBk3KQhhMq5JyjQWbaClYzokomZ5oChQwJzkDiUeVoKLEJN9Hpwvf9AtN8jAuLVWrWbANhLnyYNVvxNlnNfVvijNJuJTJ4PjHIPjXzsRWNTZqU9fgjO-iIgXGhBY0p4nKF1QdfIzBVKsYglVfjlqWo5bl9OG98Gh9yZVs2UYinC8I77Y2c6W9fg4p_x_fPynfH9CkTA</recordid><startdate>20170518</startdate><enddate>20170518</enddate><creator>Wakai, Abel</creator><creator>Lawrenson, John G</creator><creator>Lawrenson, Annali L</creator><creator>Wang, Yongjun</creator><creator>Brown, Michael D</creator><creator>Quirke, Michael</creator><creator>Ghandour, Omar</creator><creator>McCormick, Ryan</creator><creator>Walsh, Cathal D</creator><creator>Amayem, Ahmed</creator><creator>Lang, Eddy</creator><creator>Harrison, Nick</creator><creator>Wakai, Abel</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20170518</creationdate><title>Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions</title><author>Wakai, Abel ; Lawrenson, John G ; Lawrenson, Annali L ; Wang, Yongjun ; Brown, Michael D ; Quirke, Michael ; Ghandour, Omar ; McCormick, Ryan ; Walsh, Cathal D ; Amayem, Ahmed ; Lang, Eddy ; Harrison, Nick ; Wakai, Abel</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4732-6f4a0fe866edcac1d97e02fd26c074bc8743617d4cbc2a2a06134a805f727d013</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Administration, Topical</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - administration & dosage</topic><topic>Anti-Inflammatory Agents, Non-Steroidal - adverse effects</topic><topic>Anti‐Inflammatory Agents, Non‐Steroidal</topic><topic>Cornea</topic><topic>Corneal Injuries</topic><topic>Corneal Injuries - complications</topic><topic>Corneal Injuries - drug therapy</topic><topic>Diclofenac</topic><topic>Diclofenac - administration & dosage</topic><topic>Eye injuries</topic><topic>Eyes & vision</topic><topic>Flurbiprofen</topic><topic>Flurbiprofen - administration & dosage</topic><topic>Humans</topic><topic>Indomethacin</topic><topic>Indomethacin - administration & dosage</topic><topic>Ketorolac</topic><topic>Ketorolac - administration & dosage</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Outer eye</topic><topic>Pain Measurement</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Wound Healing</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wakai, Abel</creatorcontrib><creatorcontrib>Lawrenson, John G</creatorcontrib><creatorcontrib>Lawrenson, Annali L</creatorcontrib><creatorcontrib>Wang, Yongjun</creatorcontrib><creatorcontrib>Brown, Michael D</creatorcontrib><creatorcontrib>Quirke, Michael</creatorcontrib><creatorcontrib>Ghandour, Omar</creatorcontrib><creatorcontrib>McCormick, Ryan</creatorcontrib><creatorcontrib>Walsh, Cathal D</creatorcontrib><creatorcontrib>Amayem, Ahmed</creatorcontrib><creatorcontrib>Lang, Eddy</creatorcontrib><creatorcontrib>Harrison, Nick</creatorcontrib><creatorcontrib>Wakai, Abel</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wakai, Abel</au><au>Lawrenson, John G</au><au>Lawrenson, Annali L</au><au>Wang, Yongjun</au><au>Brown, Michael D</au><au>Quirke, Michael</au><au>Ghandour, Omar</au><au>McCormick, Ryan</au><au>Walsh, Cathal D</au><au>Amayem, Ahmed</au><au>Lang, Eddy</au><au>Harrison, Nick</au><au>Wakai, Abel</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2017-05-18</date><risdate>2017</risdate><volume>2017</volume><issue>5</issue><spage>CD009781</spage><pages>CD009781-</pages><issn>1465-1858</issn><issn>1469-493X</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>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.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>28516471</pmid><doi>10.1002/14651858.CD009781.pub2</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 1465-1858 |
| ispartof | Cochrane database of systematic reviews, 2017-05, Vol.2017 (5), p.CD009781 |
| issn | 1465-1858 1469-493X 1465-1858 1469-493X |
| language | eng |
| recordid | cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_6481688 |
| source | MEDLINE; Cochrane Library; EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Administration, Topical Anti-Inflammatory Agents, Non-Steroidal - administration & dosage Anti-Inflammatory Agents, Non-Steroidal - adverse effects Anti‐Inflammatory Agents, Non‐Steroidal Cornea Corneal Injuries Corneal Injuries - complications Corneal Injuries - drug therapy Diclofenac Diclofenac - administration & dosage Eye injuries Eyes & vision Flurbiprofen Flurbiprofen - administration & dosage Humans Indomethacin Indomethacin - administration & dosage Ketorolac Ketorolac - administration & dosage Medicine General & Introductory Medical Sciences Outer eye Pain Measurement Randomized Controlled Trials as Topic Wound Healing |
| title | Topical non‐steroidal anti‐inflammatory drugs for analgesia in traumatic corneal abrasions |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-27T15%3A27%3A53IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Topical%20non%E2%80%90steroidal%20anti%E2%80%90inflammatory%20drugs%20for%20analgesia%20in%20traumatic%20corneal%20abrasions&rft.jtitle=Cochrane%20database%20of%20systematic%20reviews&rft.au=Wakai,%20Abel&rft.date=2017-05-18&rft.volume=2017&rft.issue=5&rft.spage=CD009781&rft.pages=CD009781-&rft.issn=1465-1858&rft.eissn=1465-1858&rft_id=info:doi/10.1002/14651858.CD009781.pub2&rft_dat=%3Cproquest_pubme%3E1900129232%3C/proquest_pubme%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1900129232&rft_id=info:pmid/28516471&rfr_iscdi=true |