Pterygopalatine block effectiveness in postoperative period after donor cornea transplantation

Keratoplasty is a surgical procedure for corneal transplantation, in which a donor graft replaces the patient’s damaged cornea. Despite its high efficacy, the procedure carries a risk of postoperative complications (high level of intraocular pressure (IOP) and inflammatory reaction), which contribute to the development of pain syndrome and increase the risk of graft rejection due to the disruption of immune privilege.

The aim. To evaluate the efficacy of analgesia and the anti-inflammatory effect of pterygopalatine block (PPB) in the early postoperative period in patients after penetrating keratoplasty.

Material and methods. The study included 56 patients divided into two groups: Group 1 (n = 28) received PPB with 0.5 % levobupivacaine (4 ml) for 3 days, Group 2 (n = 28) received standard analgesia with NSAIDs (ketoprofen) and intraocular pressure-lowering medications (acetazolamide, timolol). Subjective pain sensations (NRS – numeric rating scale), the presence of discomfort and foreign body sensation in the eye, ocular hypertension, and the level of cytokines (IL-6, IL-8, IL-10) in the patients’ tear fluid were assessed on days 1, 3, and 5 after surgery.

Results. In Group 1, the mean pain level on the NRS was 1.2 ± 0.6 points (7.14 % of patients), while in Group 2 it was 2.9 ± 1.2 points (21.4 %) (p ≤ 0.05). On day 1 after surgery, in Group 1, the levels of IL-6 and IL-8 increased by 4.3 and 1.5 times, respectively (p  =  0.002; p = 0.001), whereas in Group 2 they increased by 4.9 and 2.1 times (p  =  0.001, p = 0.002). The concentration of IL-10 in Group 1 increased to 2.61 ± 2.3 ng/ml on day 1 and to 3.08 ± 2.6 ng/ml on day 3 (p = 0.0011; p = 0.0015), while no significant changes were observed in Group 2. The IL-6/IL-10 and IL-8/IL-10 ratios were significantly lower in Group 1 on day 3 (112.18 ± 78.55) compared to Group 2 (313.96 ± 109.87) (p = 0.0000). The correlation between IL-8 and IOP on day 3 was r = 0.8 (p = 0.0000) in Group 2 and r = 0.6 (p = 0.0049) in Group 1.

Conclusion. After donor cornea transplantation, pterygopalatine block modulates the cytokine profile with a pronounced anti-inflammatory effect, making it an effective component of comprehensive postoperative treatment. It contributes to reduced pain and improved IOP control in patients.

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