A Comprehensive Meta-Analysis on the Role of Analgesics and Anti-Inflammatories in Pan-Retinal Photocoagulation

source extracted confidence: high 2026-04-09
#humans #analgesics #anti-inflammatory-agents-non-steroidal #diabetic-retinopathy #eye-pain

A Comprehensive Meta-Analysis on the Role of Analgesics and Anti-Inflammatories in Pan-Retinal Photocoagulation

Arruda et al., 2024 | Am J Ophthalmol | Meta Analysis

Citation

Arruda Mateus P, Lima Rian V, ... Valle Giulia S Del. A Comprehensive Meta-Analysis on the Role of Analgesics and Anti-Inflammatories in Pan-Retinal Photocoagulation. Am J Ophthalmol. 2024-Nov;267:112-121. doi:10.1016/j.ajo.2024.06.018

Abstract

PURPOSE: Pan-retinal photocoagulation (PRP) is the mainstay of treatment for proliferative diabetic retinopathy (PDR), reducing the risk of severe vision loss. Pain poses a potential obstacle to effective laser delivery and patient compliance. Therefore, implementing pain relief strategies can enhance both treatment efficacy and patient comfort. DESIGN: A systematic review and meta-analysis. METHODS: We conducted a systematic review and meta-analysis according to PRISMA guidelines. The PubMed, Embase and Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) that enrolled patients undergoing PRP due to DR and compared analgesics or non-steroidal anti-inflammatory drugs (NSAID) to placebo. Pain was evaluated with the visual analogue scale. The version 2 of the Cochrane Collaboration's Risk of Bias in Randomized Controlled Trials tool and its version for crossover trials were used to assess the risk of bias. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to measure the certainty of evidence. RESULTS: A total of 13 studies were included, comprising 1404 eyes from RCTs, nine of which were crossover. Patients who were administered analgesia reported a significantly lower pain sensitivity compared to those who received placebo (Standardized mean difference [SMD] -0.38; 95% confidence interval [CI] -0.58, -0.17; P < .01; I2 = 69%). Subgroup analysis of systemic administration of analgesics/NSAIDs (metamizole, Entonox, acetaminophen, ibuprofen, caffeine, mefenamic acid, intramuscular ketorolac tromethamine, and potassium diclofenac) also showed a statistically significant reduction in pain when compared to placebo (SMD -0.28; 95% CI -0.50, -0.07; P < .01; I2 = 43%). Exclusive eye drops administration (ketorolac tromethamine 0.5% and sodium diclofenac 0.1%) also showed a significant difference in pain sensitivity (SMD -0.46; 95% CI -0.88, -0.05; I2 = 83%), however with a more significant heterogeneity. CONCLUSIONS: The results of this meta-analysis including over 1000 patients demonstrated that the use of analgesics significantly reduced pain sensitivity during PRP, and systemic analgesia is potentially better than topical administration when compared to placebo.

Key Findings

A total of 13 studies were included, comprising 1404 eyes from RCTs, nine of which were crossover. Patients who were administered analgesia reported a significantly lower pain sensitivity compared to those who received placebo (Standardized mean difference [SMD] -0.38; 95% confidence interval [CI] -0.58, -0.17; P < .01; I2 = 69%). Subgroup analysis of systemic administration of analgesics/NSAIDs (metamizole, Entonox, acetaminophen, ibuprofen, caffeine, mefenamic acid, intramuscular ketorolac tro

Outcomes Measured

  • inflammatory markers

Population

Field Value
Population See abstract
Sample Size 1000
Age Range See abstract
Condition See abstract

MeSH Terms

  • Humans
  • Analgesics
  • Anti-Inflammatory Agents, Non-Steroidal
  • Diabetic Retinopathy
  • Eye Pain
  • Laser Coagulation
  • Pain Measurement
  • Postoperative Pain
  • Randomized Controlled Trials as Topic

Evidence Classification

  • Level: Meta Analysis
  • Publication Types: Journal Article, Meta-Analysis, Systematic Review
  • Vertical: potassium

Provenance

Source extracted via PubMed E-utilities API on 2026-04-09