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Session Title: Cornea Surgical II
Session Date/Time: Wednesday 09/10/2013 | 08:00-10:30
Paper Time: 08:44
Venue: Forum (Ground Floor)
First Author: : S.Taneri GERMANY
Co Author(s): : S. Oehler S. MacRae
There is no prospective comparative trial testing the effect of a therapeutic soft contact lens (TSCL) after photorefractive keratectomy (PRK) nor after epithelial defects. We wanted to examine the influence of a therapeutic soft contact lens (TSCL) after alcohol-assisted photorefractive keratectomie (PRK) for the correction of low to moderate ametropia on visual recovery and outcome, epithelial closure, pain, and haze formation.
Zentrum für Refraktive Chirurgie, Augenabteilung am St. Franziskus Hospital, Münster, Germany
Ethics committee approval for a prospective, randomized, single center, contra-lateral, single-masked study including 35 patients was obtained. Interim results of 15 patients are presented here. The same surgeon performed bilateral PRK using a Vidaurri Fluid Retention Ring with suction (Katena, Denville, NY, USA) with 8.7mm inner diameter in order to ensure identical epithelial defect size in every eye. Ethanol 18% for 30 seconds was applied within the suction ring. Mitomycin-C was used in 10 eyes of 5 patients. Each patient received a TSCL (PureVision, Bausch&Lomb) with the same base curve of 8.6 mm and 0.0 diopter optical power in a randomized fashion in one eye only (while the contralateral eye did not receive a TSCL).
Preoperative patients corneal pachymetry showed no statistical significant difference between groups (sign test, p>0.05). Preoperative central pachymetry, optical zone size, maximum ablation depth, and targeted correction showed no statistical significant difference between groups (sign test, p>0.05). Uncorrected distance visual acuity (UDVA) improved postoperatively from day 1 to 3 months from 0.55 to 1.19 with TSCL and from 0.17 to 1.06 without TSCL, respectively. UDVA was statistically significant better on day 1 and 2 with TSCL, respectively. Epithelial defect in the first postop days was on average smaller with TSCL. Epithelium closed at day 4 in all eyes except one without TSCL. Pain perception was significantly higher without TSCL on day 1 and 2. Haze levels after 3 months were significantly lower with TSCL (with 0.11/ without 0.45, respectively). One eye without TSCL had haze grade 2 (Fantes), which persisted at the 6 months follow-up.
In our study a TSCL had statistically significant and clinically meaningful beneficial effects after surface ablation in the first days in terms of visual recovery and pain perception, and after 3 months in haze formation. Epithelial healing was slightly quicker with the use of TSCLs (not statistically, but clinically significant). This study was terminated after the interim analysis. These findings may be applicable to epithelial defects of other origin.
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