Effectiveness of ketorolac-soaked bandage contact lens for pain management after photorefractive keratectomy.

OBJECTIVE: To evaluate the effect of ketorolac-soaked contact lenses (CLs) on postoperative pain after photorefractive keratectomy (PRK) and their potential side effects including conjunctival hyperaemia and delayed epithelial healing. METHODS: This is a prospective, randomised, double-blind, contralateral eye study. A total of 310 eyes of 155 patients who underwent PRK in both eyes were included in the study. After photoablation, a 0.4% ketorolac-soaked bandage CL was placed over the cornea in Group 1, while a drug-free soft bandage CL was placed over the cornea in Group 2. The postoperative pain was evaluated using a verbal numerical rating scale. The ocular redness was compared using the black pixels (veins, and areas of redness) and white pixels (remaining areas) of the images. The complications and time to corneal wound healing were also recorded. RESULTS: The mean pain score was significantly lower in Group 1 (2.7 ± 1.3) than in Group 2 (7.4 ± 1.4) on postoperative day 1 (p < 0.001). However, on the 3rd postoperative day, there was no significant difference between the groups in terms of pain scores (p = 0.42). Preoperative eye redness was 199.2 ± 16.0 pixels in Group 1 and 200.1 ± 17.6 pixels in Group 2 (p = 0.65). There was no statistically significant difference between the two groups in terms of eye redness at the postoperative 24th and 72nd hours (p = 0.43 and p = 0.39, respectively). CONCLUSION: Soaking the bandage CL in a solution containing ketorolac 0.4% for 15 minutes could significantly lower pain scores on the first postoperative day after PRK, with no serious complications.

Facilitated Tenon-Free Conjunctival Autograft Preparation and Limited Tenon Removal Technique in Pterygium Surgery.

BACKGROUND: The main complication of primary pterygium surgery is the recurrence of the pterygium. In the present study, we aimed to compare a classical technique and facilitated tenon-free conjunctival autograft preparation and a limited tenon removal technique in pterygium surgery in terms of recurrence rate, complications, and operation duration. MATERIAL AND METHODS: This is a retrospective, comparative, observational study. Group 1 comprised 120 eyes of 115 patients who underwent pterygium excision with a new facilitated tenon-free conjunctival-limbal autograft preparation and limited tenon removal technique between May 2017 and October 2019. Group 2 comprised 117 eyes of 113 patients who underwent pterygium excision with a conventional conjunctival-limbal autograft technique between January 2016 and May 2017. RESULTS: The mean follow-up time after surgery was 18.2 ± 5.8 months in group 1 and 19.1 ± 6.3 months in group 2 (p = 0.25). The mean operation duration was 5.54 ± 1.22 (4 - 7) minutes in group 1 and 8.23 ± 1.26 (8 - 10) minutes in group 2 (p = 0.02). Flap edema was present in 33 eyes (28.2%) in group 2 and in 11 eyes (9.16%) in group 1. Flap edema was significantly higher in group 2 (p < 0.001). At the end of the 1-year follow-up of the patients, we observed recurrence in only one (0.83%) eye in group 1 and 14 (11.96%) eyes in group 2. The recurrence rate of group 1 was significantly less than that of group 2 (p < 0.001). CONCLUSIONS: The simplified technique of tenon-free conjunctival autograft preparation and limited tenon removal yielded better clinical outcomes without serious complications. Additionally, this technique shortened the surgical time and reduced surgeon-dependent factors.

The effects of trypan blue use on the corneal endothelium during cataract surgery in patients with pseudoexfoliation syndrome (PEX).

PURPOSE: In the present clinical study, it was aimed to investigate the possible effects of Trypan blue (TB) use on the corneal endothelium during cataract surgery in eyes with pseudoexfoliation syndrome (PEX) during a three-month follow-up period using the contralateral eye control design. METHODS: This prospective, randomised controlled, individual cohort study included 92 eyes of 46 patients with bilateral PEX and cataracts. While 1% TB was applied to one eye of the patients before capsulorhexis (study group), it was not applied to the other eye (control group). Both groups were compared preoperatively and postoperatively in terms of endothelial cell density (ECD), endothelial cell loss (%), pleomorphism, polymegathism and central corneal thickness (CCT) using specular microscopy. RESULTS: Preoperative corneal ECD was measured as 2362.56 ± 253.27 in the study group, 2380.84 ± 220.54 in the control group, and 2145.58 ± 221.71 in the study group and 2184.97 ± 200.94 cells/mm2 in the control group in the postoperative 3rd-month follow-up (p = 0.71 and = 0.37, respectively). In addition, there were no significant differences between the two groups in terms of the percentage of hexagonal cells, coefficient of variation (CV), and CCT both preoperatively and postoperatively 3 months later (p = 0.78, =0.39, =0.95 preoperatively and p = 0.31, =0.26, =0.83 postoperatively, respectively). CONCLUSION: This study demonstrated that the injection of 1% TB into the anterior chamber for staining the anterior capsule during cataract surgery did not cause significant corneal endothelial changes at postoperative 3rd months, despite the increased fragility of corneal endothelial cells in patients with PEX.

Toxic anterior-segment syndrome (TASS).

PURPOSE: To evaluate the clinical findings and courses of five patients who developed toxic anterior-segment syndrome (TASS) after cataract surgery and investigate the cause. MATERIALS AND METHODS: In May 2010, on the same day, ten patients were operated on by the same surgeon. Five of these patients developed TASS postoperatively. RESULTS: Patients had blurred-vision complaints on the first day after the operation, but no pain. They had different degrees of diffuse corneal edema, anterior-chamber reaction, fibrin, hypopyon, iris atrophies, and dilated pupils. Their vision decreased significantly, and their intraocular pressures increased. Both anti-inflammatory and antiglaucomatous therapies were commenced. Corneal edema and inflammation resolved in three cases; however, penetrating keratoplasty was needed for two cases and additional trabeculectomy was needed for one case. Although full investigations were undertaken at all steps, we could not find the causative agent. CONCLUSION: TASS is a preventable complication of anterior-segment surgery. Recognition of TASS, differentiating it from endophthalmitis, and starting treatment immediately is important. Controlling all steps in surgery, cleaning and sterilization of the instruments, and training nurses and other operation teams will help us in the prevention of TASS.