The Effect of Silicone Hydrogel Bandage Soft Contact Lens Base Curvature on Comfort and Outcomes After Photorefractive Keratectomy

Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review

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.

Comparison of the efficacy and safety of removing bandage contact lenses on the fourth and seventh postoperative day after transepithelial photorefractive keratectomy

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.

Management of Pain after Photorefractive Keratectomy: A Report by the American Academy of Ophthalmology

OBJECTIVE

To evaluate current best practices for postoperative photorefractive keratectomy (PRK) pain control.

METHODS

Literature searches in the PubMed database were last conducted in October 2021 and were restricted to publications in English. This search identified 219 citations, of which 84 were reviewed in full text for their relevance to the scope of this assessment. Fifty-one articles met the criteria for inclusion; 16 studies were rated level I, 33 studies were rated level II, and 2 studies were rated level III.

RESULTS

Systemic opioid and nonsteroidal anti-inflammatory drugs (NSAIDs); topical NSAIDs; postoperative cold patches; bandage soft contact lenses (BCLs), notably senofilcon A contact lenses; and topical anesthetics were demonstrated to offer significantly better pain control than comparison treatments. Some other commonly reported pain mitigation interventions such as systemic gabapentinoids, chilled intraoperative balanced salt solution (BSS) irrigation, cycloplegia, and specific surface ablation technique strategies offered limited improvement in pain control over control treatments.

CONCLUSIONS

Systemic NSAIDs and opioid medications, topical NSAIDs, cold patches, BCLs, and topical anesthetics have been shown to provide improved pain control over alternative strategies and allow PRK-associated pain to be more tolerable for patients.

Advanced morphological analysis of siloxane-hydrogel contact lenses

The purpose of this work is to provide a better understanding of three-dimensional (3-D) surface texture of siloxane-hydrogel contact lenses (CLs) using atomic force microscopy (AFM) and stereometric analysis. The 3-D surface texture characterization of unworn/worn siloxane-hydrogel CLs made of Filcon V (I FDA group) was performed with stereometric analysis. The atomic force microscopy (AFM) measurements of surface roughness and micromorphology of CLs were made using a Nanoscope V MultiMode (Bruker) in intermittent-contact mode, in air, on square areas of 5 × 5 μm. Stereometric study of 3-D surface texture was made according with ISO 25178-2:2012 for CL_rins (taken from the blister and rinsed with deionized water); CL_ss (preserved for 12 hr in saline solution and rinsed with deionized water); CL_worn-smooth (worn for 8 hr and presenting the smooth type morphology), and CL_worn-sharp (worn for 8 hr and presenting the sharp-type morphology). The 3-D surface texture of siloxane-hydrogel CLs was found to have specific morphological characteristics. Statistical parameters revealed local geometrical and morphological spatial structures at nanometer scale attributed to the specific interactions at the CLs surface. Before wear, the surface micromorphology of Filcon V CLs is regular with uniformly distributed microasperities and relatively small heights (Sq = 0.6 nm). After 12 hr in saline, it is found that the micromorphology changes relatively easily, but retaining the main morphological characteristics (Sq = 1.2 nm). After 8 hr of wear, there are two typical micromorphologies: smooth type, characterized by gutter structures and isolated microasperities (Sq = 2.5 nm), while the sharp type has an appearance with compactly arranged microasperities of hill type flanked by compactly arranged microregions of valley type (Sq = 2.2 nm). Surface statistical parameters allow manufacturers in developing the next generation of CLs with improved surface texture while improving biocompatibility and minimizing the impact of the material on corneal physiology. Furthermore, the micro-elastohydrodynamic lubrication due to surface texture at a nanometer scale between the back surface of the CL with the corneal surface and the front surface of the CL with the under-surface of the eyelid can be deeper and more nuanced to understand in light of modern tribological theories.

CLEAR - Medical use of contact lenses

The medical use of contact lenses is a solution for many complex ocular conditions, including high refractive error, irregular astigmatism, primary and secondary corneal ectasia, disfiguring disease, and ocular surface disease. The development of highly oxygen permeable soft and rigid materials has extended the suitability of contact lenses for such applications. There is consistent evidence that bandage soft contact lenses, particularly silicone hydrogel lenses, improve epithelial healing and reduce pain in persistent epithelial defects, after trauma or surgery, and in corneal dystrophies. Drug delivery applications of contact lens hold promise for improving topical therapy. Modern scleral lens practice has achieved great success for both visual rehabilitation and therapeutic applications, including those requiring retention of a tear reservoir or protection from an adverse environment. This report offers a practical and relevant summary of the current evidence for the medical use of contact lenses for all eye care professionals including optometrists, ophthalmologists, opticians, and orthoptists. Topics covered include indications for use in both acute and chronic conditions, lens selection, patient selection, wear and care regimens, and recommended aftercare schedules. Prevention, presentation, and management of complications of medical use are reviewed.

Therapeutic effects of auricular point acupressure on the recovery of patients after pterygium surgery: A pilot study

BACKGROUND

and purpose: Postoperative pain in the pterygium of the eye seriously affects patient recovery. This study was conducted to assess the efficacy of auricular point acupressure treatment on post-operative recovery in patients after pterygium surgery.

MATERIALS AND METHODS

This was a pilot, randomized controlled study. A total of 60 patients (60 eyes) were randomly assigned to two groups. After pterygium surgery, the auricular group was treated using ear acupressure (acupressure points with Cowherb seeds) and the control group was treated using sham auricular therapy (acupressure points without Cowherb seeds). Both groups were treated for one week. Outcome measures included pain score, corneal epithelial score, best-corrected visual acuity, and recurrence rate.

RESULTS

Fifty-three patients completed the study. The mean pain scores and corneal epithelial scores were significantly reduced over time in the auricular group compared with those in the control group (p < 0.05). The time-group interaction for both pain scores and corneal epithelial scores was significant between the two groups (p < 0.05). Simple main effect analysis showed the mean pain scores in the auricular group were significantly lower at each time point (the first 2-h, the first day, the third day and the first week, p < 0.05) than the control group. Mean corneal epithelial scores of the auricular group were significantly lower on the first day and third day respectively than the control group (p < 0.05). There was no significant difference in the best-corrected visual acuity or recurrence rate between the two groups (p > 0.05).

CONCLUSION

Auricular point acupressure accelerates corneal epithelium reconstruction and suppresses postoperative pain, making it an ideal adjunct treatment for postoperative pterygium recovery.

CLINICAL TRIAL REGISTRATION NUMBER

ChiCTR2000032490 on http://www.chictr.org.cn/.

Therapeutic Contact Lenses in the Treatment of Corneal and Ocular Surface Diseases-A Review

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.

Clinical Observation of Silicon Hydrogel Contact Lens Fitted Immediately after Small Incision Lenticule Extraction (SMILE)

Purpose

To examine the immediate use of bandage contact lenses (BCLs) for improving patient comfort after small incision lenticule extraction (SMILE) surgery.

Methods

This is a prospective randomized controlled study in which one hundred and seventy-eight patients undergoing SMILE were randomly allocated to three groups: group A wore BCLs for 8 hours postsurgery, group B wore BCLs for 24 hours postsurgery, and group C did not wear any BCLs postsurgery. Eight subjective symptoms including photophobia, tearing, pain, foreign body sensation, burning, blurred vision, sting, and dry eyes were prospectively evaluated at 2 hours, 4 hours, 8 hours, and 24 hours, using a questionnaire with a total score of 24. The scores of symptoms and signs were compared between the three groups.

Results

There was a statistically significant time effect on scoring, which implicated a decline in symptoms over time after surgery (P < 0.001). There was also a significant interaction between time and the treatment group (P < 0.01). The total symptom score of groups A and B (5.85 ± 3.97 and 5.99 ± 4.67, respectively) was significantly lower than that of group C at 2 hours postsurgery (7.35 ± 4.86, P < 0.05), especially in tearing and pain (P < 0.05). The level of corneal oedema at 24 hours postsurgery was also statistically significantly different between the three groups (P < 0.001), and the post hoc test showed that groups A and B were lower than group C (P < 0.01).

Conclusion

Silicon hydrogel BCLs applied immediately after SMILE surgery can relieve postsurgical symptoms of tearing and pain, improving overall patient comfort, and reduce corneal oedema. This trial is registered with ChiCTR-ONRC-13003114. Precis. The application of silicone hydrogel bandage contact lenses immediately after SMILE surgery has the potential to improve patient comfort, corneal healing, and patient satisfaction following SMILE.

Assessment of Factors Associated With Postoperative Pain After Photorefractive Keratectomy

PURPOSE

To define the factors that affect patient's self-assessed postoperative pain after photorefractive keratectomy (PRK).

METHODS

Patients who underwent PRK in 2016 were evaluated. Anonymized data collected included patient gender, age, and season at the time of surgery, ablation depth, surgeon status (attending vs. resident), topical tetracaine use, and subjective pain scores at postoperative days (PODs) 1 and 7. Average pain scores and amount of pain medication taken were analyzed for each of the previously mentioned variables.

RESULTS

Overall, 231 patients who underwent PRK were analyzed. The mean pain score and SD were 0.78 ± 1.87 on POD 1 and 0.03 ± 0.37 by POD 7. Patients who used topical tetracaine reported significantly higher pain on POD 1 and 7 compared with patients who did not use tetracaine (P < 0.001 and P = 0.038, respectively). No significant differences in pain scores were seen based on surgeon status, ablation depth, gender, and season. Patients who used topical tetracaine took a higher amount of oral pain medication (9.44 ± 6.01) compared with those who did not (7.02 ± 4.71) (P = 0.022).

CONCLUSIONS

Postoperative pain was significantly elevated in patients who used tetracaine on POD 1 and POD 7. These patients were also more likely to take oral pain medication than those who did not use topical tetracaine. Surgeon status, season, gender, and ablation depth showed no significant differences in subjective pain scores. Oral pain medication should be evaluated to assess efficacy and safety in inhibiting ocular pain after PRK.