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.

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.

Bandage contact lens for in-game corneal abrasion can allow immediate return to play.

While the prevailing treatment for corneal abrasions outside the athletic sphere is the application of a bandage contact lens (BCL), which lessens pain and allows for the maintenance of binocular vision, this is not the case during athletic play. This brief report highlights the advantage of BCLs in treating in-game corneal abrasions, ultimately allowing for an immediate return to play. Additionally, this report summarizes the mechanisms of bandage contact lenses, differentiates them from standard hydrogel contact lenses, and highlights the significant steps necessary to apply the bandage contact lens during an in-game corneal abrasion event. Overall, we link modern ophthalmology clinical practice and sports medicine, allowing for the attenuation of acutely-induced ocular pain to a manageable state.

The efficacy of bandage contact lens in relieving the aggravation of dry eye disease after complicated cataract or/and IOL surgery.

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.

Lysozyme-immobilized bandage contact lens inhibits the growth and biofilm formation of common eye pathogens in vitro.

Bandage contact lenses have an increased affinity to accumulate tear film proteins and bacteria during wear. Among the wide variety of tear film proteins, lysozyme has attracted the most attention for several reasons, including the fact that it is found at a high concentration in the tear film, has exceptional antibacterial and antibiofilm properties, and its significant deposits onto contact lenses. This study aims to evaluate the effect of lysozyme on bacterial biofilm formation on bandage contact lenses. For this purpose, several methods, including microtiter plate test and Colony Forming Unit (CFU) assay have been used to determine antibacterial and antibiofilm characteristics of lysozyme against the two most frequent contact lens-induced bacterial ocular infections, Staphylococcus aureus, and Pseudomonas aeruginosa. The results of these assays demonstrate lysozyme potential to inhibit 57.9% and 80.7% of the growth of S. aureus and P. aeruginosa, respectively. In addition, biofilm formations of P. aeruginosa and S. aureus reduced by 38.3% and 62.7%, respectively due to the antibiofilm effect of lysozyme. SEM and AFM imaging were utilized to visualize lysozyme antibacterial activity and topography changes of the contact lens surface, respectively, in the presence/absence of lysozyme. The results indicated that lysozyme can efficiently attack both gram-positive and gram-negative bacteria and consequently lysozyme-functionalized bandage contact lenses can reduce the risk of ocular infection after eye surgery.

Therapeutic contact lens-related infection by a novel pathogenic fungus Coniochaeta hoffmannii-a case report.

This study aims to report a rare instance of corneal decompensation brought on by Coniochaeta hoffmannii fungus invasion of a bandage contact lens (BCL). A 71-year-old man with pseudophakic bullous keratopathy (PBK) had BCL treatment for four months to symptomatically reduce pain and itching in his right eye. However, the patient unexpectedly lost his vision. The slit-lamp examination revealed an edematous cornea; the extensive direct inspection raised suspicion of BCL. For morphological characterization, the BCL extracted was inoculated onto 5% sheep blood agar and PDA. By Sanger sequencing method the isolate's genomic DNA was molecularly identified as C. hoffmannii.

Cold bandage contact lens use reduces post-photorefractive keratectomy or corneal collagen-crosslinking pain perception in patients.

Purpose: To compare post-operative pain perception using bandage contact lens (BCL) stored at 2-8°C (Cold BCL, CL-BCL) or room temperature (23 - 25°C, RT-BCL) after photorefractive keratectomy (PRK) or corneal collagen-crosslinking (CXL) and determine status of nociception associated factors. Methods: In this prospective interventional study, 56 patients undergoing PRK for refractive correction and 100 keratoconus (KC) undergoing CXL were recruited following approval from the institutional ethics committee with informed consent. Patients undergoing bilateral PRK received RT-BCL on one eye and CL-BCL on the other. Pain was graded by Wong-Baker scoring on the first post-operative day (PoD1). Expression of transient receptor potential channels (TRPV1, TRPA1, TRPM8), calcitonin gene-related peptide (CGRP) and IL-6 was measured in cellular content from used BCLs collected on PoD1. Equal number of KC patients received RT-BCL or CL-BCL post-CXL. Pain was graded by Wong-Baker scoring on PoD1. Results: Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL-BCL (Mean ± SD: 2.6 ± 2.1) compared to RT-BCL (6.0 ± 2.4) post-PRK. 80.4% of subjects reported reduced pain scores with CL-BCL. 19.6% reported no change or increased pain scores with CL-BCL. TRPM8 expression was significantly (P < 0.05) increased in BCL of subjects reporting reduced pain with CL-BCL compared to those who did not. Pain scores on PoD1 were significantly (P < 0.0001) reduced in subjects receiving CL-BCL (3.2 ± 2.1) compared to RT-BCL (7.2 ± 1.8) post-CXL. Conclusion: The simple approach of using a cold BCL post-operatively substantially reduced pain perception and could overcome post-operative pain-related limited acceptance of PRK/CXL.

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.

Combination of Bandage Contact Lens and Autologous Serum Eye Drop for the Treatment of Superior Limbic Keratoconjunctivitis.

Purpose: To report clinical improvement after combined treatment of bandage contact lens and autologous serum eye drop in a patient with superior limbic keratoconjunctivitis (SLK) complicated with dry eye disease (DED) and meibomian gland dysfunction (MGD). Patients and Methods: Case report. Results: A 60-year-old woman was referred for unilateral chronic recurrent redness of the left eye not responding to topical steroids and cyclosporine 0.1% eye drop. She was diagnosed with SLK, which was complicated by the presence of DED and MGD. The patient was then commenced with autologous serum eye drop and fitted with silicone hydrogel contact lens in her left eye, and treated with intense pulsed light therapy for MGD in both eyes. Remission was seen Information Classification: General serum eye drop and bandage contact lens wear. Conclusion: Long-term application of autologous serum eye drop combined with bandage contact lens can be used as an alternative treatment approach in SLK.

Contact lenses for the treatment of ocular surface diseases.

Contact lens wear is useful in ocular conditions such as high refractive errors, irregular astigmatism, corneal ectasias, corneal dystrophies, post-keratoplasty, post-refractive surgeries, trauma, and ocular surface diseases. The new innovations of highly oxygen-permeable contact lens materials have broadened the applications of contact lens suitability. Therapeutic contact lenses are medically used in the management of a wide variety of corneal conditions and ocular surface diseases. These lenses aid in pain relief, enhance corneal healing, maintain ocular homeostasis, and act as a drug delivery system. Drug delivery applications of contact lenses hold promise for improving topical therapy. The modern rigid gas permeable scleral contact lens provides symptomatic relief in painful corneal diseases such as bullous keratopathy, corneal epithelial abrasions, and erosions. It has been useful in therapeutic management as well as visual rehabilitation by enhancing the ocular surface and protecting the cornea from adverse environmental conditions. This review provides a summary of contact lenses used for the treatment of ocular surface diseases based on the current evidence available in the literature. This can help enhance the understanding and management of ocular surface diseases with respect to contact lens use in our day-to-day ophthalmology practice.

Contact lenses in dry eye disease and associated ocular surface disorders.

Dry eye disease (DED) is prevalent in all age groups and is known to cause chronic ocular discomfort and pain, and greatly affects the quality of life. Patients with ocular surface disease (OSD) may also have reduced tear secretion due to lacrimal gland damage, thus leading to aqueous deficient DED. Even with conventional management modalities such as lubricating eyedrops, topical corticosteroids, autologous serum eyedrops, or punctal plugs, many patients continue to suffer from debilitating symptoms. Contact lenses are increasingly being used in OSD providing surface hydration, protection from environmental insults, mechanical damage from abnormal lids, and as a modality for constant drug delivery to the ocular surface. This review describes the role of soft lenses and rigid gas-permeable scleral lenses in the management of DED associated with OSD. The efficacy of contact lenses, lens selection, and optimal lens fit are reviewed for specific indications.

Nocardia arthritidis scleritis: A case report.

Purpose: This report describes a case and management of a 69-year-old female with infectious scleritis found to be caused by Nocardia arthritidis species. Observations: Our patient presented with severe constant pain in the left eye (OS) following cataract surgery. She had a pertinent past medical history significant for renal transplantation (on oral tacrolimus, mycophenolate, and prednisone). Slit lamp examination OS (1 month after cataract surgery) demonstrated 3+ injection temporally accompanied by scleral thickening and multiloculated abscesses with purulent drainage from small conjunctival erosions. The abscesses were debrided and sent for gram stain and culture. The patient was treated with repeated subconjunctival injections of antibiotics and an antifungal; topical amphotericin, vancomycin, and amikacin; and oral trimethoprim-sulfamethoxazole (double strength). Two separate gram stains with cultures confirmed the diagnosis and species identification. The patient responded well to repeat subconjunctival injections early on in addition to the prescribed regimen, remaining free of disease at the last follow-up (12 months following presentation). Conclusions and Importance: This unique case demonstrates infectious scleritis caused by an uncommon Nocardia species (N. arthritidis) that was successfully treated with similar strategies used for other reported Nocardia species. As Nocardia scleritis can lead to adverse outcomes if not treated promptly and properly, it should be considered on the differential diagnoses in an immunocompromised patient who presents with acute ocular symptoms after any recent ocular surgery.

Application of 5-fluorouracil and bandage contact lens in pterygium excision combined with autogenous limbal stem cell transplantation / 国际眼科杂志(Guoji Yanke Zazhi)

AIM:To assess the clinical efficacy of 5-fluorouracil(5-FU)and bandage contact lens in the pterygium excision combined with autogenous limbal stem cell transplantation(ALSCT)in treating patients with pterygium.METHODS:Random controlled clinical trial. A total of 71 patients(71 eyes)of pterygium who treated at the department of ophthalmology in Qinhuangdao Haigang Hospital between May 2021 and November 2022 were included. They were divide into three groups, including 23 eyes received pterygium excision combined with ALSCT in group A, 24 eyes that were administered with 5-FU intraoperatively and postoperatively in group B, and 24 eyes that received both bandage contact lens and 5-FU in group C. Furthermore, comfort levels at 1, 3, 7, 14d postoperatively, corneal epithelial healing at 1, 3, 7, 14d and 1mo postoperatively, treatment outcomes and complications at 3～6mo postoperatively were compared among the three groups of patients.RESULTS:The comfort levels at 1, 3 and 7d postoperatively and corneal healing at 1 and 3d postoperatively of the group C were better than those of the groups A and B. There were no statistical significant differences in the comfort levels at 14d after surgery and corneal healing at 14d and 1mo after surgery among the three groups of patients. Over a 3～6mo follow-up period, group A experienced recurrence in 3 eyes, group B had 1 recurrence, while group C had no recurrence. There were no statistically significant differences in complication rates among the three groups of patients.CONCLUSIONS: The application of 5-FU combined with bandage contact lens can enhance postoperative comfort levels, promote corneal epithelial healing, and improve the success rate in pterygium excision combined with ALSCT.

Fabrication and Characterization of an Enzyme-Triggered, Therapeutic-Releasing Hydrogel Bandage Contact Lens Material.

PURPOSE: The purpose of this study was to develop an enzyme-triggered, therapeutic-releasing bandage contact lens material using a unique gelatin methacrylate formulation (GelMA+). METHODS: Two GelMA+ formulations, 20% w/v, and 30% w/v concentrations, were prepared through UV polymerization. The physical properties of the material, including porosity, tensile strain, and swelling ratio, were characterized. The enzymatic degradation of the material was assessed in the presence of matrix metalloproteinase-9 (MMP-9) at concentrations ranging from 0 to 300 µg/mL. Cell viability, cell growth, and cytotoxicity on the GelMA+ gels were evaluated using the AlamarBlueTM assay and the LIVE/DEADTM Viability/Cytotoxicity kit staining with immortalized human corneal epithelial cells over 5 days. For drug release analysis, the 30% w/v gels were loaded with 3 µg of bovine lactoferrin (BLF) as a model drug, and its release was examined over 5 days under various MMP-9 concentrations. RESULTS: The 30% w/v GelMA+ demonstrated higher crosslinking density, increased tensile strength, smaller pore size, and lower swelling ratio (p < 0.05). In contrast, the 20% w/v GelMA+ degraded at a significantly faster rate (p < 0.001), reaching almost complete degradation within 48 h in the presence of 300 µg/mL of MMP-9. No signs of cytotoxic effects were observed in the live/dead staining assay for either concentration after 5 days. However, the 30% w/v GelMA+ exhibited significantly higher cell viability (p < 0.05). The 30% w/v GelMA+ demonstrated sustained release of the BLF over 5 days. The release rate of BLF increased significantly with higher concentrations of MMP-9 (p < 0.001), corresponding to the degradation rate of the gels. DISCUSSION: The release of BLF from GelMA+ gels was driven by a combination of diffusion and degradation of the material by MMP-9 enzymes. This work demonstrated that a GelMA+-based material that releases a therapeutic agent can be triggered by enzymes found in the tear fluid.

Corneal diamond burr debridement for superficial non-healing corneal ulcers in cats.

OBJECTIVE: To describe the clinical outcomes and efficacy of diamond burr debridement (DBD) treatment for corneal ulceration in cats. PROCEDURE(S): Medical records of cats that received DBD at two private practices between 2015 and 2021 were retrospectively reviewed. DBD was performed using a battery-powered, handheld motorized burr and a bandage contact lens was placed in 18/21 eyes. Corneal ulceration was considered resolved if the cornea was fluorescein negative with a stable epithelial surface. Recurrence was defined as return of corneal ulceration. Descriptive statistics and a Fisher's exact test were conducted on the study population. RESULTS: Twenty-one eyes from 20 cats with superficial corneal ulcers refractory to medical treatment underwent DBD. Domestic and Burmese were the most commonly encountered breeds and the median age of affected cats was 8.83 years (range 0.5-20 years). Corneal ulceration was present for a median of 14 days prior to DBD. Healing was achieved in 81% of eyes; with four eyes failing to heal and requiring further intervention. Corneal sequestrum was reported in one case that failed to heal. Of the healed cases, three cases recurred (17.6%) at a mean of 116.3 days (range 79-135 days). Burmese were overrepresented (p < .001) in cases that failed to heal or recurred (6/7 eyes; 85.7%). The median postoperative follow-up time was 93 days (range 6-1613 days). CONCLUSIONS: Diamond burr debridement is a safe, non-invasive treatment for corneal ulceration in cats but, compared with published results, it had a lower success rate than superficial lamellar keratectomy.

Wireless-Powered Electrical Bandage Contact Lens for Facilitating Corneal Wound Healing.

Corneal injury can lead to severe vision impairment or even blindness. Although numerous methods are developed to accelerate corneal wound healing, most of them are passive treatments that rarely participate in controlling endogenous cell behaviors or are incompatible with nontransparent bandage. In this work, a wireless-powered electrical bandage contact lens (EBCL) is developed to generate a localized external electric field to accelerate corneal wound healing and vision recovery. The wireless electrical stimulation circuit employed a flower-shaped layout design that can be compactly integrated on bandage contact lens without blocking the vision. The role of the external electric field in promoting corneal wound healing is examined in vitro, where the responses of directional migration and corneal cells alignment to the electric field are observed. The RNA sequencing (RNA-seq) analysis indicates that the electrical stimulation can participate in controlling cell division, proliferation, and migration. Furthermore, the wireless EBCL is demonstrated to accelerate the completed recovery of corneal wounds on rabbits' eyes by electrical stimulation, while the control group exhibits delayed recovery and obvious corneal defects. As a new generation of intelligent device, the wireless and patient-friendly EBCL can provide a promising therapeutic strategy for ocular diseases.

Case report: Presumed contact lens-induced intracorneal hemorrhage in a diabetic dog.

A 10-year-old castrated male miniature poodle dog with diabetes mellitus was presented for a week history of blepharospasm and epiphora in the right eye. The spontaneous chronic corneal epithelial defect (SCCED) was diagnosed, and a bandage contact lens was applied following corneal debridement with sterile cotton-tip applicators. In 1 week, SCCED was improving uneventfully, though an annular pattern of intracorneal hemorrhage was observed. The contact lens was removed and the intracorneal hemorrhage resorbed in 4 weeks. To the author's knowledge, this is the first report of presumed contact lens-induced intracorneal hemorrhage characterized by an annular pattern in a dog.

Bandage contact lens soaked in 0.1% diclofenac to relieve early postoperative pain and foreign body sensation after transepithelial photorefractive keratectomy.

PURPOSE: To study the effects of a bandage contact lens immersed in 0.1% diclofenac on pain management for patients undergoing transepithelial photorefractive keratectomy (TPRK). METHODS: In a prospective, comparative, contralateral, randomized, double-masked study, we assessed a total of 51 patients. The eyes of each patient were randomly divided into two groups. After TPRK, a normal soft bandage contact lens was placed on one eye as the control group, and a bandage contact lens soaked in diclofenac was placed on the other eye as the experimental group. When the bandage contact lens was not removed, postoperative pain and other ocular discomforts were compared at 2, 18, and 24 h and 2, 3, 4, and 5 postoperative days. Patients were then examined after 1 month. Visual acuity and subepithelial haze were also evaluated. RESULTS: The mean pain score was 2.69 ± 1.96 in the control group, which was significantly higher than that in the experimental group, which received the diclofenac-soaked bandage contact lens at 2 postoperative hours. The statistical difference between the two groups' mean foreign body sensation at 2 postoperative hours was detected (p = 0.035). No differences were detected between the two groups' subepithelial haze scores or visual acuity. CONCLUSION: A bandage contact lens soaked in 0.1% diclofenac solution can be used as a potential drug-delivery system to relieve early postoperative pain and foreign body sensation after TPRK.

Use of autologous serum or Vizoovet to improve healing rates of spontaneous chronic corneal epithelial defects after diamond burr debridement in dogs.

PURPOSE: To determine whether the use of autologous serum or Vizoovet® improved healing rates of spontaneous chronic corneal epithelial defects (SCCEDs) after diamond burr debridement (DBD) in dogs. STUDY DESIGN: Two parallel group randomized prospective study with a historical control group. MATERIALS AND METHODS: Canine patients having undergone DBD for treatment of SCCEDs were included. Data for the control group (ofloxacin only) were gathered from patient records. Patients were randomly assigned to treatment groups for post-procedural medical treatments of ofloxacin and autologous serum (group 1) or ofloxacin and Vizoovet®, an all-natural eyed drop containing propolis, aloe vera, and chamomile (group 2). Each dog was examined between 2 and 3 weeks until the cornea was fluorescein stain negative. Data points collected included age, sex, breed, type of medications used, retention of bandage contact lens (BCL), time to healing, and number of DBD performed. RESULTS: A total of 120 dogs, each contributing one eye to the study, underwent DBD for SCCEDs. Mean (± standard deviation) days until healed were 20.1 ± 11.1 days, 16.3 ± 4.5 days, and 16.0 ± 3.7 days for the control group, group 1, and group 2, respectively. There was a marginally significant difference in days until healed between groups (p = .0515). SCCEDs healed significantly faster in group 2 (p = .03) and marginally faster in group 1 (p = .06) compared with the control group. Days until healing between group 1 and 2 were not significantly different (p = .76). CONCLUSIONS: As compared to the control group, use of Vizoovet® as adjunctive medical treatment resulted in shorter corneal healing time after DBD.

Comparison of the effect of removing bandage contact lens on the days 3 and 5 following photorefractive keratectomy.

AIM: To compare the outcomes of removing bandage contact lens (BCL) on days 3 and 5 after photorefractive keratectomy (PRK). METHODS: One hundred patients who underwent PRK (a total of 200 eyes) were enrolled in the present study. The subjects were assigned to two groups. Group 1 consisted of the right eyes of subjects and bandage contact lenses removal were on the 3rd day; Group 2 consisted of the fellow eyes of same subjects and removed bandage contact lenses on the 5th day after PRK. Then, data obtained from both groups were compared. To evaluate complications, the subjects underwent a slit-lamp examination in all visits. RESULTS: Filamentary keratitis was observed in one eye in both groups. The frequency of haze was higher in group 1; however, it was not significant between the two groups. Using mixed model analysis, significant differences were observed in the rate of complications as well as pain and eye discomfort scores between the groups (P < 0.05). No major complication was reported. CONCLUSION: Majority of post-PRK corneal epithelial defect is healed on day 3. However, keeping BCL for 5 days postoperatively instead of the three days produces a slightly lower rate of total complication.

Delayed Re-epithelialization After Epithelium-Off Crosslinking: Predictors and Impact on Keratoconus Progression.

Purpose: To investigate the demographic and corneal factors associated with the occurrence of delayed reepithelialization (DRE) after epithelium-off crosslinking (epi-off CXL). Design:Retrospective case series. Methods:A chart review was performed to identify patients treated with epi-off CXL. DRE was defined as a corneal epithelial defect detected by fluorescein staining that persisted for more than 10 days. Slit-lamp examination, anterior segment optical coherence tomography, corneal topography, and corneal in vivo confocal microscopy (IVCM) were always performed preoperatively and at each follow-up visit (1, 3, 6, 12 months). A generalized estimating equation was used to assess the baseline factors associated with DRE. Results:Data from 153 eyes were analyzed. The mean age of patients was 24.9 ± 8.5 years, and 47 (30.7%) were women. The average reepithelization time was 4.7 ± 1.8 days. Six eyes (3.9%) experienced DRE. In the multivariate model, both the age of the patient (OR = 1.30; p = 0.02) and the corneal steepest meridian (OR = 0.44, p = 0.047) were associated with DRE. Baseline nerve count was also associated with DRE (0.87, p = 0.03). Male gender was associated with a slower early nerve regrowth (1-6 months) (p = 0.048), but not with the occurrence of DRE (p = 0.27). Preoperative central corneal thickness was not related to DRE (p = 0.16). DRE was not associated with keratoconus progression after epi-off CXL (p = 0.520). Conclusions:The association between DRE and age may reflect the age-related decrease in the corneal healing response. Also, low baseline corneal nerve count is associated with DRE. Gender seems to affect reinnervation measured by IVCM but not the reepithelization time. DRE does not seem to affect the efficacy of epi-off CXL.