Preoperative treatment of a topical non-steroidal anti-inflammatory in photorefractive keratectomy appears to function as a preemptive analgesia, according to researchers from the Saeyan Eye Institute in South Korea. Topical ketorolac and diclofenac showed similar potencies for pain prevention, but the duration of action appeared to be longer with diclofenac.

In a comparative case series, 94 patients were randomly assigned to two groups: ketorolac group (ketorolac 0.5% in one eye and ofloxacin 0.3% in the other eye); and diclofenac group (diclofenac 0.1% in one eye and ofloxacin 0.3% in the other eye). One drop of each ophthalmic drug was applied three times to each eye 30 minutes before PRK. No other NSAID or steroid was prescribed until four days after PRK. The patients were asked to score the postoperative pain in each eye with a visual analog scale at six, 18, 24, 36, 48, 72 and 96 hours.

The natural peak of pain was located between 24 and 36 hours. Initially, the degree of pain reduction was constant for both NSAIDs; it dropped after 24 hours in the ketorolac group and after 36 hours in the diclofenac group. The postoperative time-serial pattern of the pain score changed in the diclofenac group but not the ketorolac group compared with the pattern in the ofloxacin-treated eye. The visual outcome was not affected by either NSAID and significant complications were not noticed for a mean of seven months.
J Cataract Refract Surg 2014;40:1689-1696.
^{Hong J, Nam S, Im C, Yoon S, et al.}


Intimate Partner Violence: Cause of Orbital Floor Fractures
In a retrospective chart review of facial fracture patients examined at the University of Iowa Hospitals and Clinics between January 1995 and April 2013, researchers found that intimate partner violence-associated assault was the third leading documented mechanism of injury in female orbital fracture patients. This translates into one of every 13 orbital floor fractures in female patients resulting from IPV-related assault.

A total of 1,354 women and 4,296 men sustained facial fractures during the time period reviewed. Of these, 405 women and 1,246 men sustained orbital floor fractures. The defined mechanisms of orbital floor fractures in women were, in order: motor vehicle collisions (29.9 percent); falls (24.7 percent); IPV-associated assault (7.6 percent); non-IPV-associated assault (7.2 percent). Among women with orbital fractures due to assault, leading patterns of injury included the following: isolated orbital floor fractures (12/31 IPV patients, 38.7 percent; 16/29 non-IPV patients, 55.2 percent); zygomaticomaxillary complex fractures (11/31 IPV patients, 35.5 percent; 5/29 non-IPV patients, 17.2 percent); and orbital floor plus medial wall fractures (5/31 IPV patients, 16.1 percent; 7/29 non-IPV patients, 24.1 percent). Involvement of ancillary services was documented in 20 percent (seven law enforcement and five social services agencies, 12/60) of assault-related orbital floor fracture cases. Ascertainment of patient safety was documented in 1.7 percent (1/60) of these cases.

Of note, 20.5 percent of the female orbital floor fracture patients in the study population had no etiology documented. Based on the under-reported nature of IPV, it is probable that a substantial portion of these patients also sustained injury secondary to IPV that went unreported or undocumented. Given Iowa’s relatively low rate of IPV prevalence (seventh lowest in the United States) these percentages are undoubtedly an underestimate for many sectors of the United States. Ophthalmologists treating orbital floor fracture patients should maintain a high index of suspicion for IPV and screen accordingly. Following IPV disclosure, patient safety should be assessed and referral provided.
Ophthal Plast Reconstr Surgery 2014;30:508-511.
^{Clark T, Renner L, Sobel R, Carter K, et al.}