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  • Written By: John A. Hovanesian, MD, FACS
    Cataract/Anterior Segment

    This systematic literature review of trials evaluating post-cataract surgery pain and pain management found that recovery after phacoemulsification cataract surgery is uneventful in most patients. However, in some cases, surgery is associated with significant postoperative pain.

    The importance of pain following surgery depends on who you're asking. For doctors, it's not very important. But for patients, it's a different story. Exploring postop pain as a primary outcome measure deserves some attention as we continue to refine visual results but ignore the impact of what most of us consider a "painless" procedure.

    An extensive literature search identified 21 studies of pain epidemiology and pain management after cataract surgery, but postoperative pain or postoperative pain management was not a primary aim of any of them.

    Moreover, the studies yielded inconsistent findings. Most reported no or only mild postoperative pain, but some reported moderate and severe pain and pain lasting several weeks. Interventions consisted of drug therapy, including topical nonsteroidal anti-inflammatory drugs, corticosteroids, paracetamol and perioperative intraocular injections, as well as eye pads used after surgery and various surgical techniques.

    They write that the most likely reason for inconsistent findings is the perioperative and postoperative care of the patients. More pain was reported in patients who did not have their eyes patched after surgery. Also topical and intracameral anesthetics have different efficacy profiles to prevent ocular pain, and it has been documented that some local anesthetics may induce interim cytotoxic effects on corneal cells.

    These findings reveal that postoperative pain after cataract surgery is not only associated with surgical trauma, operative complications, or postoperative inflammation, but may also be related to the use of ocular drops containing preservatives. Pharmaceutical companies should develop better tolerated ocular drops. Use of preservative-free formulas is recommended when possible.