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By: Gary M. Kawesch, MD - Exclusive
to EyeWorld
Although sometimes difficult to handle, bandage
contact lenses have strong postoperative value.
One surgeon offers an idea on making them easier
to use.
Although laser in situ keratomileusis continues
to increase in popularity, photorefractive keratectomy
still plays a role in many refractive surgical
practices, especially for lower myopes. Minor
alterations in PRK technique can help narrow the
gap we see between the two procedures in the first
3 postoperative days.
Recently, Kazuo Tsubota, MD, of Japan reported
the use of chilled balanced salt solution, applied
to the cornea prior to and after surgery, to reduce
the incidence of postoperative subepithelial haze.
I tried this, but since I don't drape my PRK patients,
I found excessive pooling of BSS in the palpebral
fissure, spilling onto the lids and lashes, and
I was quite concerned about introducing potential
sources of infection into the corneal wound. I
realized the bandage contact lenses I routinely
use post-PRK could be refrigerated, thus chilling
the cornea immediately post-procedure, with no
sloppy spillover onto the adnexa.
A recent month-long informal assessment
of this technique convinced me - patients have
less discomfort and see better, sooner. Using
the Visx Star, many patients are 20/20 by the
third postoperative day. The use of a bandage
contact lens post-PRK is widespread, and this
simple trick may alleviate some of the discomfort
and slow visual recovery PRK patients have, making
the entire experience a little more LASIK-like.
Time will tell if overall subepithelial haze is
reduced - this may require more formal study with
large numbers of patients.
I have mentored a number of surgeons learning
to use the Visx laser and find that novice PRK
surgeons often have the most difficulty applying
the bandage contact lens. Chilling the lens tends
to make it stiffer and easier to handle. I use
a simple, two-handed method to apply it. Using
a Merocel sponge, remove the lens from its packaging.
It will easily stick to the sponge. I apply the
lens to the cornea, using a cyclodialysis spatula
in my other hand to unfold the inevitably folded
lens, and the Merocel to steady the lens against
the eye. The process takes 5 to 7 seconds, is
atraumatic, and prevents eyelid or lash contact
with the lens. I prefer to use the 1-Day Acuvue
lens, with a base curve of 8.5 or 9. These lenses
are conveniently imprinted with "AV"
along the periphery, to help prevent inside-out
placement.
Implementing this simple technique will make
life easier for you and your PRK patients.
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