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Editor,—We read with interest the report by Weinberger et al,1 evaluating the analgesic effect of topical sodium diclofenac 0.1% during retinal laser photocoagulation. They found that topical sodium diclofenac 0.1% was associated with a statistically significant lower pain score compared with topical sodium chloride 0.9%, in patients receiving panretinal photocoagulation. It was concluded that topical sodium diclofenac 0.1% should be applied before panretinal photocoagulation. We agree with the authors that topical sodium diclofenac 0.1% has a better analgesic effect than topical sodium chloride 0.9% in this group of patients. However, this finding may not be clinically relevant. Topical sodium chloride 0.9% does not have any significant analgesic effect. Moreover, it is a common practice that patients receive topical anaesthetic, like oxybuprocaine 4%, before the procedure of panretinal photocoagulation. It may be more meaningful to compare the analgesic effect of these two groups of agents. There is also concern about the side effects of topical diclofenac. Ocular stinging is one of them.2 3 This may cause patient discomfort, as well as affect the rating of pain score of the panretinal photocoagulation procedure. Exacerbation of asthma by topical diclofenac has been reported.4 It may not be the appropriate analgesic in laser treatment for asthmatics and in patients with obstructive airway diseases. In summary, the role of topical diclofenac in patients receiving panretinal photocoagulation needs further evaluation.
Financial and proprietary interest: Nil.
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