A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface

Hafezi, Farhad; Hillen, Mark; Kollros, Léonard; Tan, Jerry; Awwad, Shady T.

doi:10.3390/jcm11144109

Cited by 5 publications

(3 citation statements)

References 13 publications

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“…The Dresden protocol had several limitations. As an epi-off procedure, patients require effective postoperative pain management and antimicrobial prophylaxis until the corneal epithelium has regrown [18]. The 30-min UV fluence delivery duration is slow and inconvenient for both doctor and patient [19].…”

Section: The Dresden Protocolmentioning

confidence: 99%

Expanding indications for corneal cross-linking

Hafezi

Torres-Netto

Hillen

2023

Current Opinion in Ophthalmology

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Purpose of reviewThe aim of this study was to summarize the recent developments in corneal cross-linking (CXL) and its indications, including corneal ectasias, refractive surgery and infectious keratitis. Recent findingsAdvances in CXL technology, such as the use of higher-intensity LED ultraviolet (UV) light sources and a better understanding of the UV-riboflavin photochemical reaction, have enabled safer and more effective methods of cross-linking thin and ultra-thin corneas, and more effective accelerated transepithelial/'epi-on' CXL procedures that are beginning to supplant the Dresden protocol as the 'gold standard' CXL method. CXL is also being used in combination with laser surgery, not only to expand the patient base who can receive refractive surgery, but also to help rehabilitate vision in patients with ectasia. CXL, and CXL combined with photorefractive keratectomy (PRK), can result in corneal flattening of 1--2 D, and corneal regularization of 4--5 D, respectively. Finally, photoactivated chromophore for keratitis-corneal cross-linking (PACK-CXL) has been shown to be an effective therapy for infectious keratitis, both alone, and in combination with antimicrobial drugs. SummaryCXL has evolved from a single technique to treat a single corneal ectasia, keratoconus, to several techniques with several indications, spanning a spectrum of corneal ectasias, as well as visual rehabilitation, refractive procedures and infectious keratitis treatment.

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Section: The Dresden Protocolmentioning

confidence: 99%

Expanding indications for corneal cross-linking

Hafezi

Torres-Netto

Hillen

2023

Current Opinion in Ophthalmology

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“…Limitations in the SDP have prompted the development of alternative protocols. Because SDP requires removal of the corneal epithelium, patients are typically prescribed antimicrobial prophylaxis and pain management therapy until the epithelium has healed [11]. Furthermore, the lengthy procedure is cumbersome for providers and patients [12].…”

Section: Introductionmentioning

confidence: 99%

Long-term outcomes of corneal crosslinking

Cehelyk,

Syed

2024

Current Opinion in Ophthalmology

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Purpose of review This manuscript summarizes contemporary research from 2018 to 2023 evaluating long-term (≥2 years) outcomes of corneal crosslinking (CXL) for progressive keratoconus (KCN). Recent findings The standard Dresden protocol (SDP) has been utilized clinically since the early 2000 s to treat ectatic disorders, primarily progressive KCN and postrefractive ectasia. Various modifications have since been introduced including accelerated and transepithelial protocols, which are aimed at improving outcomes or reducing complications. This review summarizes data demonstrating that the SDP halts disease progression and improves various visual and topographic indices (UDVA, CDVA, Kmax, K1, K2) up to 13 years postoperatively. Accelerated and transepithelial protocols have been found to be well tolerated alternatives to SDP with similar efficacy profiles. Studies focusing on pediatric populations identified overall higher progression rates after CXL. All protocols reviewed had excellent safety outcomes in adults and children. Summary Recent studies revealed that SDP successfully stabilizes KCN long term, and a variety of newer protocols are also effective. Pediatric patients may exhibit higher progression rates after CXL. Further research is required to enhance the efficacy and ease of these protocols.

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“…The classic postoperative treatment following PRK surgery includes the prescription of topical antibiotics and frequent preservative-free lubricants to accelerate epithelial healing [ 7 , 8 ]. The current treatment regimens also include topical steroids, topical nonsteroidal anti-inflammatory drugs (NSAIDs), and oral NSAIDs to reduce inflammation and post-PRK pain [ 9 – 11 ]. Although topical anesthetics are effective for controlling ocular surface pain, their postoperative prescription after open ocular surface corneal surgery is limited due to their known harms such as persistent corneal epithelial defects, stromal edema, stromal infiltration, and endothelial toxicity [ 12 ].…”

Section: Introductionmentioning

confidence: 99%

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

Abdel-Radi,

Eldaly,

Alattar

et al. 2023

Ophthalmol Ther

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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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A New Postoperative Regimen after CXL and PRK Using Topical NSAID and Steroids on the Open Ocular Surface

Cited by 5 publications

References 13 publications

Expanding indications for corneal cross-linking

Expanding indications for corneal cross-linking

Long-term outcomes of corneal crosslinking

Preservative-Free Topical Anesthetic Unit-Dose Eye Drops for the Management of Postoperative Pain Following Photorefractive Keratectomy

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