{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,8]],"date-time":"2026-10-08T05:23:32Z","timestamp":1791437012058,"version":"4.3.3"},"reference-count":13,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2022,7,15]],"date-time":"2022-07-15T00:00:00Z","timestamp":1657843200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Light for Sight Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Corneal epithelium removal during photorefractive keratotomy (PRK), TransPRK, or corneal cross-linking (CXL) means that patients experience pain and inflammation after the procedure, which need to be carefully managed with topical drug regimens. One highly effective class of topical analgesics is non-steroidal anti-inflammatory drugs (NSAIDs), but these must be used carefully, as their use has been associated with delayed re-epithelialization and, in rare cases, corneal melting. However, our clinical experience has been that the concomitant use of topical corticosteroids obviates this risk. Here, we present a mechanistic explanation for our observations, our TransPRK and epithelium-off CXL protocols, and the postoperative medication regimens where topical NSAIDs are used in combination with topical steroid therapy during the first two postoperative days (where pain and inflammation levels are the highest). We detail the results of a single-center retrospective case analysis that examined eyes that underwent TransPRK (n = 301) or epithelium-off CXL (n = 576). Topical NSAID use in the first two postoperative days to control pain and inflammation after PRK\/TransPRK or epithelium-off CXL, when used in combination with topical steroid therapy, does not appear to be associated with corneal melting or delayed epithelial healing. This approach may represent an improvement over current methods of handling post-surgical pain in procedures that require corneal epithelial debridement.<\/jats:p>","DOI":"10.3390\/jcm11144109","type":"journal-article","created":{"date-parts":[[2022,7,17]],"date-time":"2022-07-17T22:57:06Z","timestamp":1658098626000},"page":"4109","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8935-4558","authenticated-orcid":false,"given":"Farhad","family":"Hafezi","sequence":"first","affiliation":[{"name":"Laboratory for Ocular Cell Biology, Center for Applied Biotechnology and Molecular Medicine, University of Zurich, 8006 Zurich, Switzerland"},{"name":"ELZA Institute, 8953 Dietikon, Switzerland"},{"name":"Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland"},{"name":"Department of Ophthalmology, University of Southern California, Los Angeles, CA 90007, USA"},{"name":"Department of Ophthalmology, Wenzhou Medical University, Wenzhou 325015, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark","family":"Hillen","sequence":"additional","affiliation":[{"name":"ELZA Institute, 8953 Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1046-8275","authenticated-orcid":false,"given":"Leonard","family":"Kollros","sequence":"additional","affiliation":[{"name":"ELZA Institute, 8953 Dietikon, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jerry","family":"Tan","sequence":"additional","affiliation":[{"name":"Jerry Tan Eye Surgery, Singapore 228208, Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shady T.","family":"Awwad","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, American University of Beirut Medical Center, Beirut 1107, Lebanon"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1016\/j.optom.2014.09.001","article-title":"Corneal Regeneration after Photorefractive Keratectomy: A Review","volume":"8","author":"Hanneken","year":"2015","journal-title":"J. Optom."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"243","DOI":"10.1136\/bjo.77.4.243","article-title":"Photorefractive keratectomy: Implications of corneal wound healing","volume":"77","author":"Tuft","year":"1993","journal-title":"Br. J. Ophthalmol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"620","DOI":"10.1016\/S0002-9394(02)02220-1","article-title":"Riboflavin\/ultraviolet-a-induced collagen crosslinking for the treatment of keratoconus","volume":"135","author":"Wollensak","year":"2003","journal-title":"Am. J. Ophthalmol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1097\/ICU.0000000000000486","article-title":"Pain management after photorefractive keratectomy","volume":"29","author":"Golan","year":"2018","journal-title":"Curr. Opin. Ophthalmol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1565","DOI":"10.1016\/S0161-6420(94)38032-8","article-title":"The effects of topical corticosteroids and plasmin inhibitors on refractive outcome, haze, and visual performance after photorefractive keratectomy. A prospective, randomized, observer-masked study","volume":"101","author":"Lohmann","year":"1994","journal-title":"Ophthalmology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.survophthal.2019.07.001","article-title":"NSAID-induced corneal melt: Clinical importance, pathogenesis, and risk mitigation","volume":"65","author":"Rigas","year":"2020","journal-title":"Surv. Ophthalmol."},{"key":"ref_7","first-page":"1129","article-title":"Corneal melting associated with use of topical nonsteroidal anti-inflammatory drugs after ocular surgery","volume":"118","author":"Lin","year":"2000","journal-title":"Arch. Ophthalmol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"343","DOI":"10.1016\/S0161-6420(01)00930-7","article-title":"Possible role of the vitamin E solubilizer in topical diclofenac on matrix metalloproteinase expression in corneal melting: An analysis of postoperative keratolysis","volume":"109","author":"Hargrave","year":"2002","journal-title":"Ophthalmology"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000878","DOI":"10.1136\/bmjophth-2021-000878","article-title":"Pain mechanisms and management in corneal cross-linking: A review","volume":"6","author":"Pump","year":"2021","journal-title":"BMJ Open Ophthalmol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1167\/iovs.02-0488","article-title":"Alcohol debridement of the corneal epithelium in PRK and LASEK: An electron microscopic study","volume":"44","author":"Browning","year":"2003","journal-title":"Investig. Ophthalmol. Vis. Sci."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1080\/02713683.2019.1666996","article-title":"Preoperative Anxiety Levels and Pain during Cataract Surgery","volume":"45","author":"Socea","year":"2019","journal-title":"Curr. Eye Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"F181","DOI":"10.1152\/ajprenal.1992.263.2.F181","article-title":"Prostanoid biosynthesis and mechanisms of action","volume":"263","author":"Smith","year":"1992","journal-title":"Am. J. Physiol. Ren. Physiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1730","DOI":"10.1073\/pnas.73.5.1730","article-title":"Inhibition of arachidonic acid release from cells as the biochemical action of anti-inflammatory cortico-steroids","volume":"73","author":"Hong","year":"1976","journal-title":"Proc. Natl. Acad. Sci. USA"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4109\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:51:17Z","timestamp":1760140277000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/14\/4109"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,15]]},"references-count":13,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2022,7]]}},"alternative-id":["jcm11144109"],"URL":"https:\/\/doi.org\/10.3390\/jcm11144109","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,15]]}}}