Analgesic efficacy of 7 different topical NSAIDs in panretinal photocoagulation-associated pain

Background To investigate the effects of different topical non-steroidal anti-inflammatory drugs (NSAIDs) and demographic characteristics on pain perception associated with pan-retinal photocoagulation. Methods Before pan-retinal photocoagulation, patients received one of seven topical NSAIDs, while the control group received artificial tears. Following pan-retinal photocoagulation, subjective pain was assessed using the visual analog scale. The impact of demographic factors and NSAID type on visual analog scale scores was statistically analyzed. Demographic data were compared using the Mann-Whitney U test and NSAID groups with one-way ANOVA. Results The study included 270 eyes from 270 patients. No significant differences were observed among NSAID groups regarding age, gender, diabetes duration, diabetic retinopathy type, number of intravitreal injections, pan-retinal photocoagulation sessions, or photocoagulation energy. In all participants, pain perception was higher in females (P < 0.001), patients aged ≤ 60 years (P < 0.001), and those with proliferative diabetic retinopathy (P < 0.001). Bromfenac (P < 0.001), indomethacin (P < 0.001), nepafenac 0.3% (P = 0.002), and diclofenac (P = 0.029) significantly reduced pain, whereas ketorolac trometamol, nepafenac 0.1%, and flurbiprofen did not. Among the effective NSAIDs, nepafenac 0.3% and diclofenac were ineffective in males, while diclofenac showed no efficacy in patients over 60 years of age or those with proliferative diabetic retinopathy. No NSAID demonstrated a significant effect in non-proliferative diabetic retinopathy patients. Conclusions Bromfenac and indomethacin demonstrate consistent analgesic efficacy in nearly all patients with pan-retinal photocoagulation-related pain, while nepafenac 0.3% and diclofenac are effective in a majority of cases. However, heightened pan-retinal photocoagulation-related pain in females, patients aged ≤ 60 years and those with proliferative diabetic retinopathy may necessitate careful consideration in these populations.