Abstract
Purpose To assess the efficacy of applying bandage contact lens (BCL) in reducing the fibrotic healing response of flap margins following femtosecond laser in situ keratomileusis (FS-LASIK). Methods In this prospective, randomized, interventional, observer-masked trial, 41 patients (82 eyes) with myopia and/or myopic astigmatism were scheduled to undergo FS-LASIK. After surgery, patients were fitted with a BCL in one eye (BCL eyes, n=41) but not in the contralateral eye (control eyes, n=41), following randomized allocation of the BCL to the left or right eye of each patient. The BCL was left in place overnight and removed the following morning. All eyes subsequently received standardized postoperative treatments. Patients were followed up for 6 months. We evaluated patients' self-reported postoperative symptom scores for pain, photophobia, tearing, and foreign-body sensation. At 6 months after surgery, we examined the corneal flap margin and adjacent regions, and photographed them using slit-lamp biomicroscopy, to subjectively evaluate the wound healing response. Results Postoperative pain and photophobia were milder in the BCL group than in the control group (P=0.041 and P=0.003, respectively), but patients felt more foreign-body sensation in the eye with a BCL than in the control eye (P=0.001). There was no significant difference in tearing score between BCL eyes and control eyes (P=0.118). Regarding the fibrotic healing response of the flap margin, control eyes showed a wide, bright peripheral circumferential band with a spiculated edge and high reflectivity; conversely, BCL eyes showed a markedly narrower and smoother peripheral circumferential band, with a less spiculated edge and lower reflectivity (P < 0.001). Conclusion Patients felt less discomfort in eyes treated with a BCL after FS-LASIK than in control eyes. BCL-treated eyes also had a less intense wound healing response at the flap margins than control eyes in some of patients. BCLs may merit consideration as a treatment option after FS-LASIK for special patients. This trial is registered with ChiCTR1800016579.
Highlights
In addition to our patients reporting relief of postoperative pain, as well as observing promotion of corneal epithelialization, we found that the circular scars of flap margins in eyes fitted with a bandage contact lenses (BCLs) were narrower and less reflective than those without BCLs
BCLs are widely used after corneal refractive surgery, including laser-assisted subepithelial keratomileusis (LASEK) or photorefractive keratectomy, because they protect the corneal wound, prompt the corneal epithelium to heal, and relieve patients’ discomfort [7,8,9]. ey are frequently applied to keep the flap in its proper position after laserassisted in situ keratomileusis (LASIK) and prevent corneal flap–related complications, such as buttonhole flaps, partial flaps, free caps, epithelial defects, and postoperative traumatic dislocation of LASIK flaps [10, 12, 13]
We found that BCL significantly reduced the fibrotic wound healing response of the flap margins at 6 months after FS-LASIK. e BCL eyes had smoother, narrower, less spiculated, and less reflective circumferential bands than control eyes
Summary
Fibrotic wound healing at the flap margin is associated with corneal inflammation induced by the femtosecond laser, which differs from the reaction to the mechanical microkeratome. Other than medication for alleviating postoperative inflammation, no treatment has been recommended to date to Journal of Ophthalmology prevent or alleviate the wound healing response. Whether this flap complication could affect the clinical outcome, including postoperative visual acuity and refraction is unknown. Many studies have confirmed the therapeutic effects of BCLs after corneal refractive surgery in alleviating discomfort, facilitating healing by re-epithelialization, promoting visual recovery, and decreasing the risk of postoperative infection [7,8,9]. Our preliminary study about BCLs focused on the corneal epithelialization, not on the flap margins, and this retrospective study could not draw a firm conclusion. erefore, we conducted a prospective, randomized controlled study to evaluate the performance of BCLs by assessing subjective symptoms and slit-lamp findings
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
