Pain management after photorefractive keratectomy.

PURPOSE: To evaluate the effect of a bandage contact lens soaked in ketorolac ophthalmic 0.45% solution (Acuvail) on pain modulation in patients having transepithelial photorefractive keratectomy (PRK). DESIGN: Prospective case series. SETTING: Narayana Nethralaya Superspeciality Eye Hospital, Bangalore, India. METHODS: Eyes of patients were divided into 2 groups. After transepithelial PRK, a regular soft bandage contact lens was placed in Group 1 and a ketorolac-soaked bandage contact lens was placed in Group 2. The patients were matched for age and sex in the 2 groups. Postoperative pain was compared using the validated Wong-Baker pain scale. Before placement of a ketorolac-soaked bandage contact lens in patients' eyes, the safety of the procedure was checked using cultures from the bandage contact lens and measuring the quantity of the drug adsorbed and the elution profile over time with ultra-high-performance liquid chromatography (UHPLC). RESULTS: Each group comprised 35 eyes of 35 patients. The mean pain score was 7.95 ± 2.12 (SD) in Group 1, which was significantly higher than in Group 2 (2.76 ± 0.85), which received the ketorolac-soaked bandage contact lens. The UHPLC results showed that the soaked bandage contact lens acted as a depot for ketorolac, which was released onto the ocular surface over time, providing postoperative pain relief without causing adverse events. CONCLUSION: A bandage contact lens soaked in ketorolac 0.45% solution can act as a potential drug depot that can reduce pain after transepithelial PRK.

Biomechanics of LASIK Flap and SMILE Cap: A Prospective, Clinical Study.

PURPOSE: To analyze the acute effect of flap cut in laser in situ keratomileusis (LASIK) eyes and cap cut in small incision lenticule extraction (SMILE) eyes on corneal biomechanical properties of patients undergoing surgery. METHODS: This was a prospective, interventional, longitudinal case series. Forty-eight eyes of 24 patients underwent contralateral LASIK and SMILE. Corvis ST (Oculus Optikgeräte GmbH, Wetzlar, Germany) measurements were performed preoperatively, intraoperatively, and 1 week and 1 month after surgery. In LASIK eyes, the flap was cut but not lifted before intraoperative measurements. In SMILE eyes, the cap and side cut incision were made before intraoperative measurement. Thirty biomechanical variables were analyzed, assuming multiple comparisons. RESULTS: In LASIK and SMILE eyes, 36.7% and 13.3% of the total number of variables detected biomechanical weakening after flap and cap cuts (P = .02), respectively. Further, 13.3% and 40% of the total variables detected no biomechanical changes after flap and cap cut, respectively (P = .03). These acute biomechanical effects of flap and cap cuts did not influence 1-week and 1-month measurements (P > .05) because both LASIK and SMILE eyes showed similar biomechanical weakening. CONCLUSIONS: Flap and cap cuts induced biomechanical weakening in patient corneas. The flap caused more weakening than the cap intraoperatively. However, biomechanical differences between LASIK and SMILE eyes were similar after removal of tissue and ongoing wound healing. [J Refract Surg. 2019;35(5):324-332.].