Effect of Bandage Contact Lens Exchange on Pain and Healing After Photorefractive Keratectomy—A Randomized Control Trial

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.

Bandage contact lens use after photorefractive keratectomy: updated review

“…Recently, AlDahash et al achieved that BCL exchange during the first PRK postoperative day vaguely reduce pain score and not vary epithelial recovery. 7 In conclusion, Samfilcon A, with the higher oxygen permeability and water content, reported the lowest pain score and reepithelization zone on postoperative day 1. The differences between the materials were no longer statistically significant on the third day after the PRK surgery.…”

“…Recently, AlDahash et al achieved that BCL exchange during the first PRK postoperative day vaguely reduce pain score and not vary epithelial recovery. 7…”

“…The main study characteristics are presented in Table 1. [2][3][4][5][6][7] The mean age of the patients was 25.98 ± 3.83 years. The mean follow-up postoperative was 2.51 ± 0.98 days.…”

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

“…Exchanging BCL every day after PRK lowered postoperative pain on day 1 (P¼0.009) compared with the eye treated with the same BCL without exchange, whereas the response was similar thereafter. 44 The removal of BCL on the fourth or seventh postoperative day did not affect the pain response on day 1 (P¼0.20). The removal of BCL on the seventh postoperative day had lower pain scores compared with the removal on the fourth postoperative day (P¼0.07).…”

“…The studies reported uniform administration of postoperative medication regimens such as antibiotics, steroids (betamethasone, loteprednol, prednisolone, and fluorometholone), NSAIDs (diclofenac, nepafenac, and ketorolac), and opioids (in few studies) were applied to both eyes including control or between comparisons of BCLs eyes after PRK. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Among other outcomes, epiphora scores and comfort scores improved by day 3 after surgery on BCL application, whereas photophobia scores and foreign body sensation decreased by the third day after surgery. 35,37,42,54,55 Pain is known to subside when re-epithelialization of the cornea is completed.…”