Effects of the pharmaceutical formulation of topical medications on corneal epithelial healing after phototherapeutic keratectomy.

PURPOSE: To determine the effect of the formulation of topical medications on the healing of corneal epithelial cells after phototherapeutic keratectomy (PTK). STUDY DESIGN: Retrospective cohort study. METHODS: We studied 271 eyes of 189 consecutive patients (aged 67.6 ± 11.8 years) who had undergone PTK for granular corneal dystrophy (n = 140), band keratopathy (n = 47), or lattice corneal dystrophy (n = 2). Postoperatively, generic or brand-named levofloxacin, 0.1% betamethasone, or 0.1% bromfenac sodium hydrate was applied topically. Patients were examined on postoperative days 1, 2, and 5 and weekly thereafter. The time to re-epithelialization was assessed by use of Kaplan-Meier and Cox proportional hazards analyses. RESULTS: The time to re-epithelialization was significantly longer with generic 0.5% levofloxacin, at 8.2 ± 3.5 days, than with 0.5% Cravit (levofloxacin), at 6.7 ± 3.5 days (P = 0.018), or with 1.5% Cravit, at 6.3 ± 2.6 days (P = 0.000). In addition, the time to re-epithelialization was significantly longer with generic 0.1% betamethasone (Sanbetason), at 7.3 ± 3.4 days, than with brand-name 0.1% betamethasone (Rinderon), at 6.1 ± 2.5 days (P = 0.0002). The Cox proportional hazards model indicated that the use of generic formulations for levofloxacin eye drops and 0.1% betamethasone was a significant factor that delayed corneal re-epithelialization (hazard ratio [HR] = 0.72, P = 0.002 and HR = 0.77, P = 0.006, after adjustment for age). Re-epithelialization was significantly shorter in band keratopathy than in corneal dystrophy (HR = 1.56, P = 0.004). No other factors, including age, bandage contact lens, and diabetes mellitus, were significantly associated with time to re-epithelialization. CONCLUSION: Corneal epithelial healing can be significantly affected by different antibacterial or steroid eye drops. Clinicians need to be aware that a generic formulation may affect corneal epithelial healing.

The Stop and Press Technique; an Occlusion Free Stop-and-Chop Technique in Cataract Patients with Soft to Moderate Nuclei.

The stop-and-chop technique, which involves occlusion and chopping using vacuum to stabilize the nucleus, is an excellent combination of the divide-and-conquer and phaco-chop techniques. However, effectively chopping an un-solid (soft to moderate) nucleus is not easy, since the optimal vacuum to hold an un-solid nucleus is often associated with breaking of occlusion and aspiration of the nucleus. We modified the stop-and-chop technique such that occlusion and tight nucleus holding using ultrasound (US) power is not necessary. After completing the central groove and cracking the nucleus into two hemi-sections, the right nucleus half is chopped without nucleus rotation and occlusion. The right hemi-nucleus is stabilized by pressing against the right sac with the US tip without occlusion. Since this technique can reduce the risk of nucleus perforation and posterior capsular rupture, the surgeons can place the US tip firmly in a deep position, which provide safe and efficient nucleus division.