Though corneal collagen cross-linking (CXL) is an increasingly available and effective treatment for keratoconus, few reports have considered its impact on pain-related physiology in depth. This comprehensive narrative review summarises mechanisms underlying pain in CXL and clinical care possibilities, with the goal of future improvement in management of CXL-related pain. Postoperative pain associated with CXL is largely due to primary afferent nerve injury and, to a smaller extent, inflammation. Chronification of pain after CXL has not been reported, even as long-term nerve damage without regeneration following standard CXL treatment is frequently observed. The lack of pain chronification may be due to the minimally invasive nature of the procedure, with its rapidly recovering superficial corneal wound, and to the positive anti-inflammatory changes of the tear film that have been described after CXL. Different CXL approaches have been developed, with the transepithelial epithelial-on technique (epi-on) associated with less postsurgical pain than the gold standard, epithelial-off technique (epi-off). After the first few days, however, the difference in pain scores and need for analgesics between epi-on and epi-off disappear. Patients experience relatively high-intensity pain the first few days post-CXL, and many strategies for acute pain control following CXL have been studied. Currently, no method of pain management is considered superior or universally accepted. Acute pain following CXL is a recognised and clinically significant side effect, but few CXL studies have systematically investigated postoperative pain and its management. This review aims to improve patient pain outcomes following this increasingly common procedure. No data are available. Not applicable.

中文翻译：

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角膜交联的疼痛机制和管理：综述


尽管角膜胶原交联 (CXL) 是一种越来越可用且有效的圆锥角膜治疗方法，但很少有报告深入考虑其对疼痛相关生理学的影响。这篇全面的叙述性综述总结了 CXL 疼痛的机制和临床护理的可能性，目标是未来改善 CXL 相关疼痛的管理。与 CXL 相关的术后疼痛主要是由于原发性传入神经损伤，以及较小程度上的炎症。尽管经常观察到标准 CXL 治疗后没有再生的长期神经损伤，但 CXL 后疼痛的慢性化尚未见报道。疼痛没有慢性化可能是由于该手术的微创性质，其浅表角膜伤口快速恢复，以及 CXL 后描述的泪膜的积极抗炎变化。人们已经开发出不同的 CXL 方法，其中跨上皮上皮附着技术 (epi-on) 比金标准上皮脱落技术 (epi-off) 术后疼痛更少。然而，在最初几天后，开始和结束之间疼痛评分和镇痛药需求的差异消失了。患者在 CXL 后的最初几天会经历相对高强度的疼痛，并且已经研究了 CXL 后急性疼痛控制的许多策略。目前，没有一种疼痛管理方法被认为是优越的或被普遍接受的。 CXL 术后的急性疼痛是一种公认​​的、具有临床意义的副作用，但很少有 CXL 研究系统地研究术后疼痛及其治疗。本综述旨在改善这种日益常见的手术后患者的疼痛结果。无可用数据。不适用。