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APPLYING a bandage contact lens after refractive laser surgery provides no benefits for the majority of patients, suggests a prospective multicentre German study presented at the XXI Congress of the ESCRS.
Surgeons at the Philipps University LASIK Centre in Marburg performed 70 consecutive bilateral myopic LASIK procedures. Colleagues at the Gutenberg University LASIK Centre in Mainz performed myopic LASIK surgery on another 30 patients. Following LASIK, the Marburg team applied topical ofloxacin, dexamethasone jelly, and a patch on the first eye. The second eye received an Etafilcone A bandage contact lens (water content 58%; central thickness = 0.07 mm; penetration coefficient, DK = 28) soaked in the antibiotic/steroid combination that the surgeons then covered with a patch. The Mainz team followed the same protocol, except they used Omafilcone A bandage contact lenses (water content 60%; central thickness = 0.065 mm; penetration coefficient, DK = 27). The bandage contact lens was removed on the day after surgery. Visual acuity testing done at that time showed UCVA of 0.6 in the eyes with the lenses and 0.7 in the eyes without them. "The bandage contact lens provided increased postoperative comfort in less than one-third of patients. Our results suggest that the bandage contact lens is most effective in patients with good preoperative tolerance to contact lenses and high Schirmer values," he noted. The investigators noted microstriae in 18 bandage contact lens eyes and in 16 eyes that did not receive the lenses. The microstriae did not appear to cause a reduction in the BCVA of patients in either group. Microstriae incidence increased with ablation depth. Retroillumination photography at three months follow-up showed that 31% of patients in the Marburg group had microstriae, as did 40% of those in the Mainz study group. A slight majority of all patients (54%) did not like the effect of the contact lens because of what they described as a disturbing foreign body effect. By contrast, 27% of patients liked the bandage contact lens because it gave them a "safe feeling". The remaining 19% reported no apparent difference between the two eyes. The patients who did not like the bandage contact lenses had mean Schirmer test results of 12.3 mm. The average age of these patients was 35 years, with females outnumbering males by more than two to one. Seventy-eight percent had a history of contact lens use, of whom 50% had developed intolerance. These values differed slightly in the patients who did like the bandage contact lens. They had higher mean Schirmer test results (16.3 mm), indicating better tear secretion. Eighty-nine percent of these patients used contact lenses with only 33% developing intolerance. The average age of this group was 36 years, evenly balanced by gender. Patients who neither liked nor disliked the bandage contact lens had mean Schirmer tests of 14.9 mm. The average age was 38.8, with females outnumbering males. Almost all, 89%, had worn contact lenses, with 41% developing intolerance. Dr Sekundo said that the study suggests that the bandage contact lens may be better tolerated by males than by females. The patients who preferred the bandage contact lens option also tended to have good preoperative tolerance to contact lenses and higher Schirmer test scores. "Upon the conclusion of the study, we decided not to use bandage contact lenses routinely after LASIK because the bandage contact lens provided increased postoperative comfort in less than one-third of patients. Our results suggest that the bandage contact lens is most effective in patients with good preoperative tolerance to contact lenses and high Schirmer values," Dr Sekundo told listeners Another German surgeon, Michael Knorz MD, takes different measures to avoid post-LASIK discomfort. He explained that although pain is generally not an issue after LASIK, people are different and some may experience some pain: "I therefore like to minimise the risk of pain in several ways. First, I give every patient a tablet of 50 mg diclofenac 30 minutes prior to surgery. Second, I administer a drop of diclofenac eye drops immediately after surgery. Third, I instruct patients to use artificial tears every waking hour on the day of surgery." Thomas Kohnen MD of Goethe-University in Frankfurt also shared his views on post-LASIK pain with EuroTimes, "Some patients do experience discomfort following LASIK. It is expected though, as some level of discomfort ensues following any type of surgery. It is not a problem, however, since the discomfort is generally not excessive. "I do not use an additional bandage contact lens, as the eyelid itself is the eye's best protection. I ask patients to keep their eyes closed for 4-6 hours following LASIK. Any discomfort they have passes by the evening of the operation day. The closed eye also serves to curb the appearance of microstriae." Dr Kohnen warned that in his experience, bandage contact lenses could be the cause of infections following LASIK surgery, making their postoperative use yet less attractive. Walter Sekundo MD Prof. Michael Knorz MD
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