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Travé-Huarte S, Wolffsohn JS. Bilateral Sutureless Application of Human Dehydrated Amniotic Membrane with a Specialised Bandage Contact Lens for Moderate-to-Severe Dry Eye Disease: A Prospective Study with 1-Month Follow-Up. Clin Ophthalmol 2024; 18:1329-1339. [PMID: 38765455 PMCID: PMC11100494 DOI: 10.2147/opth.s458715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/28/2024] [Indexed: 05/22/2024] Open
Abstract
Purpose To assess changes in symptoms and ocular surface signs following a bilateral sutureless treatment of dehydrated amniotic membrane (dAM) under a specialised bandage contact lens (sBCL) in patients with moderate-to-severe dry eye disease (DED). Patients and Methods In this prospective pre-post interventional study, 35 patients diagnosed with moderate-to-severe DED, with an Ocular Surface Disease Index (OSDI) score >30 on current treatment, were enrolled. Assessments were conducted at baseline (day -30), after 30 days run-in with no additional treatment (day 0 - control), and 30 days post sBCL+dAM treatment (day 30 - treatment). Intervention involved two successive bilateral 4-5 day sutureless applications of dAM (17mm diameter, with a 6 mm central aperture, Omnigen® VIEW) under an 18mm sBCL (OmniLenz®). Symptomatology and ocular signs were measured using OSDI, Dry Eye Questionnaire-5 (DEQ-5), Symptom Assessment iN Dry Eye (SANDE), and other ocular surface health indicators including non-invasive breakup time, corneal and conjunctival staining, and lid wiper epitheliopathy length and width (LWE). Results While symptomatology remained stable during the 30-day no-treatment run-in, 1-month post-dAM treatment, there was a significant reduction in OSDI scores (from 55.8 to 32.3, p<0.001), DEQ-5 (from 14.6 to 10.0, p<0.001), SANDE frequency (from 65.2 to 43.6, p<0.001), and SANDE severity (from 59.8 to 41.1, p<0.001). Additionally, there was a notable decrease in the width of LWE staining, from grade 2 (50-75% of the lid wiper) to grade 1 (25-50% of the lid wiper) (p=0.011). Conclusion A bilateral 8-10-day treatment duration with dAM applied with sBCL demonstrated a 31 to 42% improvement in symptomatology and a decrease in ocular surface signs of mechanical stress. This innovative bilateral treatment approach offers a promising treatment modality for patients with refractory moderate-to-severe DED.
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Affiliation(s)
- Sònia Travé-Huarte
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, UK
| | - James S Wolffsohn
- Optometry and Vision Science Research Group, College of Health and Life Sciences, Aston University, Birmingham, UK
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Chen D, Xu D, Wu X, Wang J, Sheng S, Yu X, Lin X, Liu L, Ge X, Zhao H, Xu W. The efficacy of bandage contact lens in relieving the aggravation of dry eye disease after complicated cataract or/and IOL surgery. BMC Ophthalmol 2024; 24:141. [PMID: 38549070 PMCID: PMC10976755 DOI: 10.1186/s12886-024-03385-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 03/07/2024] [Indexed: 04/01/2024] Open
Abstract
PURPOSE In the present study, we aimed to evaluate the efficacy of the bandage contact lens (BCLs) in the treatment of dry eye disease (DED) after complicated cataract or/and intraocular lens (IOL) surgery. METHODS In this retrospective, single-centered, observational study, we collected data from 69 patients who underwent complicated cataract or/and IOL surgery. Of these, 35 cases wore their own BCLs immediately after the operation, while the other 34 cases did not have their own BCLs and were instead covered with gauze. The Ocular Surface Disease Index (OSDI) questionnaire, slit-lamp microscope examination, keratograph analysis, and Schirmer I test were measured at baseline, 1 week and 1 month postoperatively. RESULTS In the BCL group, the score of the OSDI questionnaire was significantly decreased at 1 week and 1 month postoperatively compared with baseline levels (P = 0.000, collectively). Moreover, the fluorescein staining score of the BCL group was remarkably decreased 1-week and 1-month postoperatively compared with the non-BCL group (P = 0.000 and P = 0.000, respectively). Furthermore, the redness score of the BCL group was also better compared with the non-BCL group at 1 week and 1 month postoperatively (P = 0.014 and P = 0.004, respectively). CONCLUSIONS Complicated cataract or/and IOL surgery would intensify the DED. Early application of BCLs postoperatively improved patients' comfort and alleviated dry eye-related symptoms and signs. Furthermore, this mechanism might involve the acceleration of corneal epithelial healing, the alleviation of ocular stress response and the stabilization of the tear film. TRIAL REGISTRATION Trial registration ClinicalTrials, NCT04120389. Registered 10 October 2019-retrospectively registered.
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Affiliation(s)
- Dan Chen
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Dejian Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
- Lemolight Ophthalmology Hospital, Hangzhou, Zhejiang, China
| | - Xingdi Wu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Jingwen Wang
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Siting Sheng
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Xuewen Yu
- Department of Ophthalmology, The First People's Hospital of Xiaoshan District, Xiaoshan Affiliated Hospital of Wenzhou Medical University, Hangzhou, Zhejiang, China
| | - Xueqi Lin
- Department of Ophthalmology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Lirui Liu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Xian Ge
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
- Jianyang Eye Hospital of Jianhu County, Jiangsu, China
| | - Huiling Zhao
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China
| | - Wen Xu
- Eye Center, The Second Affiliated Hospital, School of Medicine, Zhejiang Provincial Key Laboratory of Ophthalmology, Zhejiang Provincial Clinical Research Center for Eye Diseases, Zhejiang University, Zhejiang Provincial Engineering Institute on Eye Diseases, Hangzhou, Zhejiang, China.
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Abdel-Radi M, Eldaly Z, Alattar S, Goda I. Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy. Ophthalmol Ther 2023; 12:3025-3038. [PMID: 37665497 PMCID: PMC10640409 DOI: 10.1007/s40123-023-00791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023] Open
Abstract
INTRODUCTION Ocular pain is a common complication following photorefractive keratectomy (PRK). The level of patient satisfaction with current pain control strategies is not high. This study aims to assess the efficacy and safety of a novel regimen of preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops for post-PRK pain control. METHODS In a contralateral eye study, 144 eyes of 72 patients who underwent bilateral transepithelial PRK (TransPRK) were stratified into experimental and control groups. The experimental group received preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops five times daily postoperatively until complete epithelial healing, while the control group received sodium hyaluronate 0.2% instead. The main outcome measures were pain scores assessed by the verbal rating scale and visual analogue scale (VRS, VAS), the corneal epithelial defect (CED) area, epithelial healing duration evaluated by slit-lamp biomicroscopy and anterior segment optical coherence tomography (AS-OCT), and endothelial cell density (ECD) measured before and 1 month after surgery. RESULTS Pain scores assessed by VRS and VAS were significantly lower in the experimental group 8 h after surgery, and 1, 2, and 3 days postoperatively (P < 0.001). The mean CED area showed no significant differences between the two groups at different follow-ups (P value > 0.05). The corneal epithelial healing had a mean duration of 3.32 ± 0.47 days in both studied groups and was parallel in both eyes of each patient. In each group, 49 eyes (68%) and 72 eyes (100%) had a fully epithelialized surface on the third and fourth postoperative days, respectively. No significant changes were observed in the mean ECD 1 month following surgery in both groups (P value > 0.05). CONCLUSION Preservative-free oxybuprocaine hydrochloride 0.4% unit-dose eye drops are effective and safe in controlling early postoperative pain following TransPRK. The availability of the single-dose unit preparation can overcome the problem of topical anesthetic abuse. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05733741.
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Affiliation(s)
- Mahmoud Abdel-Radi
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt.
| | - Zeiad Eldaly
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Sara Alattar
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
| | - Islam Goda
- Department of Ophthalmology, Assiut University Hospital, Assiut University, 6th Floor, Asyût , 71516, Egypt
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Zheng Y, Zhai CB. Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review. Eye Contact Lens 2023; 49:449-458. [PMID: 37816246 PMCID: PMC10734785 DOI: 10.1097/icl.0000000000001021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2023] [Indexed: 10/12/2023]
Abstract
ABSTRACT This study systematically reviewed the performance of bandage contact lenses (BCL) such as lotrafilcon A, lotrafilcon B, senofilcon A, balafilcon A, and comfilcon A as postoperative treatment in different ocular surgeries. A systematic search of English and Chinese databases (from inception to December 2021) was conducted for studies reporting the efficacy of BCLs after ocular surgeries. Postoperative symptoms, corneal healing, and visual outcomes were studied. Overall, 38 studies were identified. Bandage contact lens was applied as a postoperative aid in corneal refractive, cataract, and vitrectomy surgeries. Most studies were on photorefractive keratectomy. Reduced postoperative symptoms were observed within 4 hr to 3 days, whereas re-epithelization of the cornea and healing was complete within 3 to 7 days after ocular surgeries except for vitrectomy. In a vitrectomy, greater comfort and improved corneal epithelium were observed on the seventh day after surgery. An improvement in dry eye symptoms was observed at 7 days with considerable benefits observed after 1 month of cataract surgery. These findings indicate that BCLs are effective for improving postoperative symptoms and facilitation of early visual rehabilitation with a wear time of 8 hr to 7 days depending on the type of ocular surgery.
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Affiliation(s)
- Yan Zheng
- Beijing Tongren Eye Center (Y.Z.), Beijing KEY Laboratory of Ophthalmology and Visual Science; and Beijing Tongren Hospital (C.-B.Z.), Capital Medical University, Beijing, China
| | - Chang-Bin Zhai
- Beijing Tongren Eye Center (Y.Z.), Beijing KEY Laboratory of Ophthalmology and Visual Science; and Beijing Tongren Hospital (C.-B.Z.), Capital Medical University, Beijing, China
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Zhou H, Jin Y, Tong G, Zhao G, Wu H. Comparison of the efficacy and safety of removing bandage contact lenses on the fourth and seventh postoperative day after transepithelial photorefractive keratectomy. Heliyon 2023; 9:e21129. [PMID: 37886779 PMCID: PMC10597848 DOI: 10.1016/j.heliyon.2023.e21129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 10/10/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023] Open
Abstract
Purpose To compare the differences in the removal of bandage contact lenses (BCLs) at 4 and 7 days after transepithelial photorefractive keratectomy (TransPRK) in term of visual rehabilitation, eye discomfort, and postoperative complications. Methods This retrospective cohort study included patients with myopia undergoing TransPRK; in Group 1, the BCLs were removed on the 4th postoperative day, while in Group 2, the BCLs were removed on the 7th postoperative day. All patients underwent a 6-month follow-up, including slit-lamp examination and visual acuity assessment. Subjective evaluations of pain and eye discomfort were recorded after the BCLs removal. Results In total, 376 eyes of 191 patients in Group 1 and 346 eyes of 177 patients in Group 2 were enrolled. The two groups were matched for sex, age, preoperative corrected distance visual acuity, and tear film break-up time. Patients in Group 1 exhibited slightly lower levels of myopia, resulting in a shallower ablation depth and shorter ablation time than those in Group 2. No statistically significant differences in visual acuity recovery, haze severity, and incidence of infectious keratitis were observed within 6 months after surgery between the two groups. However, patients in Group 2 experienced significantly fewer discomfort symptoms (discharge, foreign body sensation, and blurred vision) after BCLs removal than patients in Group 1 and had fewer postoperative complications (recurrent corneal epithelial erosion). Conclusion Delayed removal of the BCLs one week after TransPRK effectively alleviated early discomfort symptoms and reduced the risk of recurrent corneal epithelial erosion without increasing the likelihood of infectious keratitis.
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Affiliation(s)
- Hangshuai Zhou
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Yanhua Jin
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Gengmin Tong
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Guangjin Zhao
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
| | - Hongyan Wu
- Department of Ophthalmology, Dongyang People's Hospital, Dongyang, China
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Wang Y, Jacobs DS. Role of therapeutic contact lenses in management of corneal disease. Curr Opin Ophthalmol 2022; 33:306-310. [PMID: 35779054 DOI: 10.1097/icu.0000000000000859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current review highlights areas of innovation and research in the use of contact lenses in the treatment of corneal ectasia and ocular surface disease. RECENT FINDINGS A series of academic reports were published by a committee of experts reviewing evidence-based practice patterns of contact lens use. There continues to be active research in the use of contact lenses in the management of keratoconus, including mini-scleral lenses, custom impression-based scleral lenses and wavefront-guided scleral lenses. Recent reports on contact lenses for ocular surface disease were primarily reviews, retrospective case reports or case series, with publications on contact lens use in corneal epithelial defects, graft-vs.-host disease, limbal stem cell deficiency and neurotrophic keratitis. There are recent publications on advances in drug-eluting contact lenses. SUMMARY Corneal specialists should be aware of current advances in the field of contact lens expanding their use in corneal ectasia and ocular surface disease.
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Affiliation(s)
- Yvonne Wang
- Department of Ophthalmology, Yale School of Medicine, New Haven, Connecticut
| | - Deborah S Jacobs
- Department of Ophthalmology, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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Sánchez-González MC, Sánchez-González JM, Gargallo-Martínez B, De-Hita-Cantalejo C. Comparison of the effect of removing bandage contact lens on the days 3 and 5 following photorefractive keratectomy. Int Ophthalmol 2022; 42:1355-1356. [DOI: 10.1007/s10792-021-02148-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/17/2021] [Indexed: 11/30/2022]
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Bandage Contact Lens use after Photorefractive Keratectomy: The Updated Review. J Cataract Refract Surg 2021; 48:741-742. [PMID: 34753881 DOI: 10.1097/j.jcrs.0000000000000861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 11/01/2021] [Indexed: 11/26/2022]
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9
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Soeken TA, Ross AE, Kohane DS, Kuang L, Legault GL, Caldwell MC, Brundridge WL, Merkley MB, Ciolino JB, Townley JR. Dexamethasone-Eluting Contact Lens for the Prevention of Postphotorefractive Keratectomy Scar in a New Zealand White Rabbit Model. Cornea 2021; 40:1175-1180. [PMID: 34294635 DOI: 10.1097/ico.0000000000002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/28/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate the safety and efficacy of an experimental dexamethasone-eluting contact lens (DCL) for the prevention of postphotorefractive keratectomy (PRK) corneal haze in a New Zealand White (NZW) rabbit model. METHODS Both eyes of 29 NZW rabbits underwent PRK. The rabbits were randomized to one of the 5 study arms for 4 weeks: tarsorrhaphy only, tarsorrhaphy and bandage contact lens (BCL) replaced weekly, tarsorrhaphy and BCL for 1 week plus topical 0.1% dexamethasone ophthalmic solution (drops) for 4 weeks, tarsorrhaphy and BCL replaced weekly plus topical dexamethasone for 4 weeks, and tarsorrhaphy and DCL changed weekly for 4 weeks. Each week for 4 consecutive weeks postoperatively, the tarsorrhaphies were opened, the eyes underwent evaluation and imaging, and the tarsorrhaphies were replaced. Contact lenses were cultured on removal. Central corneal haze was assessed weekly with corneal densitometry. After 4 weeks, the animals were killed, and the eyes were enucleated for histopathologic analysis. RESULTS The tarsorrhaphy only group displayed more haze with a greater change in optical densitometry from pre-op compared with the other treatment groups. There was no difference between the DCL group and the groups receiving a BCL and dexamethasone drops in densitometry or histopathology. No NZW rabbits developed clinical signs of infection, and cultures from DCLs and BCLs grew similar organisms. CONCLUSIONS In the post-PRK rabbit model, DCLs worn weekly for 4 weeks were safe and as effective at preventing corneal haze as 0.1% dexamethasone drops applied 4 times a day for 4 weeks.
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Affiliation(s)
- Timothy A Soeken
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Amy E Ross
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Daniel S Kohane
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; and
| | - Liangju Kuang
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
| | - Gary L Legault
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Matthew C Caldwell
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Wesley L Brundridge
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Michael B Merkley
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
| | - Joseph B Ciolino
- Department of Ophthalmology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, MA
- Laboratory for Biomaterials and Drug Delivery, Department of Anesthesiology, Division of Critical Care Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA; and
- Departments of Anesthesia and Surgery, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - J Richard Townley
- Department of Ophthalmology, San Antonio Uniformed Services Health Education Consortium, San Antonio, TX
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Abdelwahab SM, Salem MH, Elfayoumi MA. Single-Step Transepithelial Photorefractive Keratectomy in Low to Moderate Myopia: A One-Year Follow-Up Study. Clin Ophthalmol 2021; 15:3305-3313. [PMID: 34408389 PMCID: PMC8363478 DOI: 10.2147/opth.s326048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/27/2021] [Indexed: 11/23/2022] Open
Abstract
Aim To evaluate predictability, safety, efficacy, and visual outcome of StreamLight. ™ (SL.), the newly released single-step transepithelial photorefractive keratectomy platform by Alcon WaveLight™ (WL). Methods In this prospective cohort study, photorefractive keratectomy (PRK) was conducted on 500 eyes of 250 patients seeking myopic refractive vision correction. The new single-step transepithelial PRK method was applied, using the SL. platform installed in the WL. Ex 500 excimer laser machine. Patients were followed up to monitor intensity and duration of postoperative pain, as well as speed of epithelial healing in the early post-operative period and visual acuity, postoperative refraction and development of postoperative haze for one year post-operatively. Results Average pain duration was 1.5 days, and the mean pain intensity score on a scale of 0–10 was 3.74 + 1.51. Mean postoperative spherical equivalence was 0.01 ± 0.38 D, and the final postoperative uncorrected distance visual acuity (UCDVA) was 20/20 in 98% of eyes included in this study. None of the eyes lost more than one Snellen chart line or developed visually significant postoperative haze during the follow-up period. Conclusion The new SL. platform for transepithelial PRK is a safe, accurate platform, offering an easier early post-operative recovery, with no compromise in final visual outcome. ![]()
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Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy-A Randomized Control Trial. Eye Contact Lens 2021; 47:113-117. [PMID: 33492010 DOI: 10.1097/icl.0000000000000730] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/04/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the corneal re-epithelialization and patient-perceived pain after bandage contact lens (BCL) exchange on day one, after photorefractive keratectomy (PRK). METHODS A randomized controlled trial, of all patients who underwent bilateral transepithelial-PRK (trans-PRK) or bilateral alcohol debridement and PRK (A-PRK), between March and October 2019. One eye of each patient was randomly assigned to BCL exchange on the first postoperative day (exchange group) and the BCL was not exchanged in the fellow eye (control group). Patients were evaluated daily until healing was complete. At each visit, the corneal epithelial defect was measured, and a questionnaire was used to assess pain, photophobia, and excessive tearing. P<0.05 was statistically significant. RESULTS The study sample was comprised of 56 patients (mean age 27.2±5.7 years). Trans-PRK was performed in 20 (34.5%) and A-PRK in 36 (64.3%) patients. At day 3, 40 (71.4%) eyes of the exchange group healed completely compared with 38 (67.9%) eyes of the control group (P=0.5). At day-1 follow-up, the pain score was 1.87±1.4 in the exchange group and 2.29±1.3 in the control group (P=0.009). The mean pain score was 1.58±1.4 among patients who underwent A-PRK and 2.35±1.2 among patients operated by trans-PRK (P=0.04). CONCLUSION The epithelial healing did not vary when BCL was exchanged one day after refractive surgery. However, postoperative pain score after PRK was lower at day 1, when the BCL was exchanged. Compared with A-PRK, trans-PRK group demonstrated a higher pain score in the early postoperative phase.
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Fogla R, Luthra G, Chhabra A, Gupta K, Dalal R, Khamar P. Preferred practice patterns for photorefractive keratectomy surgery. Indian J Ophthalmol 2021; 68:2847-2855. [PMID: 33229660 PMCID: PMC7856967 DOI: 10.4103/ijo.ijo_2178_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Over the past two decades, excimer laser-based refractive surgery procedures have been successfully established for their safety and satisfactory visual outcomes. Surface ablation procedures or photorefractive keratectomy (PRK) are practised commonly for the correction of refractive errors including myopia, astigmatism and hyperopia. Satisfactory visual outcomes are achieved in majority of cases, although a very small percentage have issues related to corneal haze, regression, and its associated visual disturbances. To ensure optimal outcomes and to minimize complications, certain keys to success have been designed on the basis of the current review of literature on surface ablation procedures.
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Affiliation(s)
- Rajesh Fogla
- Senior Consultant, Cataract, Cornea and Laser Refractive Surgeon, Director Cornea Clinic, Apollo Hospitals, Hyderabad, Telangana, India
| | - Gaurav Luthra
- Cataract and Refractive Surgeon, Director, Drishti Eye Institute, Dehradun, Uttarakhand, India
| | - Aishwarya Chhabra
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Krati Gupta
- Cornea and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
| | - Ritika Dalal
- Refractive Surgeon and Dry Eye Specialist, Dr Dalal's Clinic, Mumbai, Maharashtra, India
| | - Pooja Khamar
- Department of Cataract and Refractive Surgery, Narayana Nethralaya, Bangalore, Karnataka, India
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Ozarslan Ozcan D, Ozcan SC. Efficacy of two silicone-hydrogel bandage contact lenses after corneal crosslinking. Clin Exp Optom 2021; 104:505-509. [PMID: 33689606 DOI: 10.1080/08164622.2021.1878838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Silicone-hydrogel (SiH) contact lenses are frequently used as a bandage after anterior segment surgical procedures. Several types of lenses may exhibit clinical performances with different characteristics. This study aims to evaluate the efficacy of two SiH contact lenses following corneal crosslinking (CXL). Forty-nine keratoconus patients scheduled for consecutive CXL surgery in both eyes were included in this comparative, double-blind, prospective study. A Balafilcon A (Pure Vision 2 HD, Bausch+Lomb, Rochester, NY, USA) or Lotrafilcon B (Air Optix Aqua, Ciba Vision, Duluth, GA, USA) lens was fitted in a randomised fashion in the eyes at the end of the CXL. Remaining epithelial defect area measured by slitlamp biomicroscopy, subjective level of pain and discomfort with visual analogue scale (VAS) and total number of oral analgesics taken were evaluated and compared at post-operative days 0, 1, 2 and 3. The average epithelial defect size was significantly smaller in the eyes with Lotrafilcon B than the eyes with Balafilcon A at post-operative Day 1 (31.2 ± 4.3 mm2 and 33.8 ± 5.2 mm2, respectively, p < 0.001) and Day 2 (8.2 ± 3.6 mm2 and 10.5 ± 5.4 mm2, respectively, p = 0.039). There was no statistically significant in the average epithelial defect size between the groups at Day 3 (p = 0.859). Re-epithelialisation time was similar in both groups (p = 0.317) There was no statistically significant difference in VAS scores regarding the lens type in any post-operative follow-up. The mean oral analgesic numbers were similar in both groups (p = 0.217). SiH contact lenses can be used as an effective bandage for corneal re-epithelialisation after CXL. The material and features of bandage contact lens used after CXL may affect the corneal re-epithelialisation process. Lotrafilcon B lens showed faster re-epithelialisation at post-operative days 1 and 2 after CXL.
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Affiliation(s)
- Deniz Ozarslan Ozcan
- Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
| | - Sait Coskun Ozcan
- Department of Ophthalmology, Mustafa Kemal University Tayfur Ata Sökmen Faculty of Medicine, Hatay, Turkey
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Wu X, Ma Y, Chen X, He S, Lin X, Yu X, Chen W, Luo C, Xu W. Efficacy of bandage contact lens for the management of dry eye disease after cataract surgery. Int Ophthalmol 2021; 41:1403-1413. [PMID: 33507461 PMCID: PMC8035101 DOI: 10.1007/s10792-021-01692-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 01/08/2021] [Indexed: 12/02/2022]
Abstract
Purpose We aimed to evaluate the efficacy of bandage contact lens (BCL) for the management of dry eye disease (DED) after cataract surgery. Methods A total of 120 patients (140 eyes) with age-related cataract and DED were enrolled in this study. Patients underwent standard micro-incision phacoemulsification surgeries and were divided into control or BCL groups. Slit-lamp biomicroscopic examination, Ocular Surface Disease Index, keratograph analysis and Schirmer I test were executed, and the levels of tear inflammatory molecules were detected. Results In the control group, the NIAvg-BUT and Schirmer I test scores were significantly decreased at 1 week post-operation compared with baseline levels (P = 0.035 and P = 0.009, respectively). In the BCL group, the NIF-BUT and Schemer I test scores were significantly improved at 1 month after operation compared with the control group (P = 0.012 and P < 0.001, respectively). Levels of IL-6, IL-8 and ICAM-1 were significantly increased in the control group at 1 month after the operation (P = 0.005, P = 0.038 and P = 0.022, respectively), while there was no difference in the BCL group. The increase in the IL-6 level in the control group was significantly higher compared with that in the BCL group (P = 0.047). In DED patients, there were significant correlations between ocular surface parameters and inflammatory molecules. Conclusions Cataract surgery could lead to the development or worsening of DED. The application of BCLs after cataract surgery could stabilize the ocular surface and tear film, improve the corneal healing and reduce the inflammation. Collectively, our findings suggested that proper use of BCLs after cataract surgery played an effective role in the management of DED. Trial registration ClinicalTrials, NCT04100031. Registered 18 September 2019—retrospectively registered
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Affiliation(s)
- Xingdi Wu
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yajuan Ma
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Zhejiang Rongjun Hospital, Jiaxing, China
| | - Xiang Chen
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Suhong He
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Suichang Hospital of Traditional Chinese Medicine, Suichang, China
| | - Xueqi Lin
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Xuewen Yu
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Weijie Chen
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.,Linhai First People's Hospital, Linhai, China
| | - Chenqi Luo
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China
| | - Wen Xu
- Eye Center, Affiliated Second Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, China.
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Tourabaly M, Knoeri J, Leveziel L, Bouheraoua N, Ameline B, Borderie V. Prevention of infection after corneal refractive surgery: a French survey. J Cataract Refract Surg 2021; 47:27-32. [PMID: 32826703 DOI: 10.1097/j.jcrs.0000000000000396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 07/30/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To report the French refractive surgeons' real-life practices for preventing infection after corneal refractive surgery (photorefractive keratotomy [PRK], laser in situ keratomileusis [LASIK], and small-incision lenticule extraction). SETTING France. DESIGN Anonymous practice survey. METHODS The questionnaire was sent in a single email invitation to 400 declared refractive surgeons. The following information was recorded between December 2019 and April 2020, before the coronavirus pandemic: demographics data, preoperative evaluation and preparation of the patient, surgical management, immediate and postoperative protocol, and infections reported after corneal refractive surgery. RESULTS Eighty-three of 400 surgeons (20.75%) responded to the questionnaire; 55 (66.0%) performed more than 50 corneal refractive surgeries a year, and 25 (30.1%) performed more than 200 procedures a year. Thirty-six (43.4%) surgeons wore 3 protective items, 37 (44.6%) 2, 5 (6.0%) 1, and 5 (6.0%) zero. Seventy-seven (92.8%) surgeons used povidone-iodine for skin area disinfection and 54 (65%) for conjunctival fornix disinfection. The contact time of povidone-iodine was less than 3 minutes for 71 (85.0%) surgeons. Twenty surgeons (24.1%) reported at least 1 postrefractive surgery infection. Twenty percent of surgeons who wore sterile gloves for PRK reported postoperative infections compared with 62.5% for those who did not (P = .008). These figures were, respectively, 8.7% and 66.7% for the use of sterile gloves during LASIK (P = .002); 8.9% of surgeons who wore surgical masks for LASIK reported postoperative infections compared with 50.0% for those who did not (P = .01). CONCLUSIONS Practices are variable among French refractive surgeons. Wearing a surgical mask and sterile gloves during corneal refractive surgery appears to be advisable.
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Affiliation(s)
- Moïse Tourabaly
- From the Quinze-Vingts National Ophthalmology Hospital, Sorbonne University (Tourabaly, Knoeri, Leveziel, Bouheraoua, Ameline, Borderie), and the Vision Institute, Sorbonne University (Bouheraoua, Borderie), Paris, France
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Lim L, Lim EWL. Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases-A Review. Asia Pac J Ophthalmol (Phila) 2020; 9:524-532. [PMID: 33181548 DOI: 10.1097/apo.0000000000000331] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Therapeutic contact lenses (TCLs) are often used in the management of a wide variety of corneal and ocular surface diseases (OSDs). Indications of TCL include pain relief, enhancing corneal healing, corneal sealing, corneal protection, and drug delivery. For painful corneal diseases such as bullous keratopathy, epidermolysis bullosa, and epithelial abrasions/erosions, bandage contact lenses (BCLs) provide symptomatic relief. Postoperatively in photorefractive keratectomy or laser epithelial keratomileusis, BCLs also alleviate pain. In severe OSDs such as severe dry eye, Stevens-Johnson syndrome/toxic epidermal necrolysis, gas-permeable scleral contact lenses are often used to enhance corneal healing. BCLs are used post-keratoplasty, post-trabeculectomy, and post-amniotic membrane transplantation to enhance healing. BCLs, with or without glue adhesives, are used to seal small corneal perforations and sometimes also used as bridging treatment before penetrating keratoplasty in larger corneal perforations. In patients with eyelid conditions such as trichiasis, ptosis, and tarsal scarring, BCLs are also effective in forming a mechanical barrier to protect the cornea. A relatively new use for TCLs is in ocular drug delivery where TCLs are used to maintain therapeutic concentrations of medication on the ocular surface. Contraindications of the use of TCLs include infective keratitis, corneal anesthesia, and significant exposure keratopathy with inadequate eyelid position or movement. Complications of TCL include infective keratitis, corneal hypoxia and associated complications, corneal allergies and inflammation, and poor lens fit. Overall, TCLs are effective in the treatment of corneal and OSDs but contraindications and complications must be considered.
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Affiliation(s)
- Li Lim
- Singapore National Eye Center, Singapore
- Singapore Eye Research Institute, The Academia, Singapore
- Duke-NUS Medical School, Singapore
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Azarcon CP, dela Cruz RC. Rebound tonometry measurements over extended-wear bandage contact lenses. Cont Lens Anterior Eye 2020; 43:503-506. [DOI: 10.1016/j.clae.2020.02.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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18
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Ripa M, Betts B, Dhaliwal S, Wang K, Pouly S, Chen D, Mifflin M. Survey of Postoperative Pain in Photorefractive Keratectomy Using Topical versus Oral Nonsteroidal Anti-Inflammatory Drugs. Clin Ophthalmol 2020; 14:1459-1466. [PMID: 32546954 PMCID: PMC7266408 DOI: 10.2147/opth.s255441] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To evaluate and compare postoperative pain following photorefractive keratectomy (PRK) in patients using a preventive regimen of oral versus topical nonsteroidal anti-inflammatory drugs (NSAIDs). Patients and Methods A prospective, randomized, longitudinal survey of postoperative PRK pain was performed on 157 subjects in a tertiary academic medical center setting. Patients were randomized to either topical ketorolac 0.4% every 12 hours or oral naproxen sodium 220 mg every 12 hours for 72 hours following PRK, beginning at the time of surgery. The primary outcome measure was the daily peak pain score from the validated numerical rating scale (NRS) for five days after surgery. Results The peak pain scores were significantly higher in the oral NSAID group (mean 5.82, SD 1.94) compared to the topical NSAID group (mean 4.2, SD 2.19) (p<0.0001) after PRK. When comparing each postoperative day after PRK, the pain scores from 24 to 48 hours (day 2) were significantly higher in the oral NSAID group (mean 5.17, SD 2.25) as compared to the topical NSAID group (mean 3.21, SD 2.09) (p<0.0001). Pain scores 24–72 hours after surgery (days 2 and 3) were higher than pain scores on days 1, 4, and 5 for both groups. Conclusion Twice daily oral naproxen sodium 220 mg is inferior to twice daily topical ketorolac 0.4% in the treatment of early postoperative pain after PRK. This study also identified a consistent trend in which pain scores were highest 24–72 hours after the procedure. This additional observation may be useful in understanding, preventing, and treating post-PRK pain.
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Affiliation(s)
- Madeline Ripa
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Brent Betts
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Shagun Dhaliwal
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Kaidi Wang
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Severin Pouly
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
| | - Danli Chen
- Division of Epidemiology, University of Utah, Salt Lake City, UT, USA
| | - Mark Mifflin
- Department of Ophthalmology and Visual Sciences, John A. Moran Eye Center, University of Utah, Salt Lake City, UT, USA
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