Pain After Myopia Surgery: Is It A Must?

When a patient consults for a preoperative assessment for myopia surgery, this consultation is an opportunity to answer the various questions that the candidate for refractive surgery may ask, and among these questions is that of pain. This is a frequently asked question.

The first surgical technique for myopia operations was radial keratotomy, which involved making scalpel incisions on the cornea’s surface. This technique, which gave rise to the pain of varying intensity but fairly short duration, is no longer used today.

Chronologically, the technique that was then proposed was the excimer laser in refractive photo keratectomy technique. (PKR) or its variants which are grouped under the term surface techniques. Because it creates a veritable ulceration of the cornea, the healing of which takes 48 to 72 hours, this technique is rightly known to be painful, although the intensity of the pain varies from one patient to another. However, we have the means to control pain, on the one hand, thanks to the prescription of painkillers, and on the other hand, with the use by most surgeons of contact lenses called dressing lenses, placed on each eye at the end of the intervention and left in place for 2 or 3 days, i.e., until good superficial healing is obtained.

Lasik in kraff eye institute for example, practiced for 20 years, was presented from the start as a technique that has, compared to the PKR, the advantage of being painless. This is true, and this is explained anatomically by the absence of ulceration of the cornea since the area sculpted by the laser is protected under the corneal flap. This painless character is to be modulated because the first 3 or 4 postoperative hours after Lasik are generally accompanied by a sensation of grains of sand under the eyelids, the intensity of which can sometimes resemble real pain. This post-Lasik pain, however, differs from post-PKR pain by its brevity since it does not exceed a few hours, and it is quite possible to go about your business the day after a Lasik.

The simpler nature of the postoperative period explains why Lasik and eye surgery for myopia is preferred whenever possible. However, the PKR retains indications when Lasik is not possible, and it is then necessary to accept the omen of this transient pain since, in the end, the long-term results appear identical for the two methods in low myopia and averages. The new tools which enrich the arsenal of surgical techniques for myopia and astigmatism will perhaps allow, in the years to come, the revival of certain incisional techniques, carried out with the femtosecond laser, without breaking the ocular surface, and therefore potentially painless.