Benefits and side effects of bandage soft contact lens application after LASIK: a prospective randomized study.
OBJECTIVE
To evaluate benefits and side effects of bandage soft contact lens (BSCL) insertion after LASIK in relation to patients' characteristics.


METHODS
Prospective, randomized, bicenter comparative investigational trial.


METHODS
One hundred patients (200 eyes) with myopia and/or myopic astigmatism.


METHODS
Each patient underwent consecutive (Marburg, Germany) or simultaneous (Mainz, Germany) bilateral LASIK. At the end of the procedure, the first treated eye received a drop of ofloxacin and dexamethasone, patch, and transparent protective shield for 2 to 4 hours. The fellow eye received in addition a BSCL, soaked in the same eyedrops for 20 to 24 hours.


METHODS
Schirmer II test results, first-day uncorrected visual acuity (UCVA), and tolerance of contact lens wear (poor, moderate, good) were recorded. Patients' subjective preference for the BSCL on the first postoperative day was graded as more comfortable than fellow eye, no difference, or less comfortable. Three months after surgery, the corneal flap was photographed in retroillumination for objective evaluation of microstriae. Statistical significance was determined using the Kruskal-Wallis 1-way analysis of variance on ranks test.


RESULTS
Fifty-four percent of patients felt discomfort in the eye that had the BSCL (contra-BSCL subgroup), whereas 27% enjoyed having a BSCL (pro-BSCL subgroup). The remaining 19% felt no difference. The average Schirmer II value was 16.6 mm (+/-7.7) in the pro-BSCL subgroup, 14.9 mm (+/-6.4) in the no difference subgroup, and 12.3 mm (+/-7.7) in the contra-BSCL subgroup. There was a female preponderance in the contra-BSCL (39:15) and no difference (15:6) subgroups. A preoperative history of poor contact lens tolerance was recorded in 50% of the contra-BSCL subgroup patients; 41%, no difference; and 33%, pro-BSCL. Postoperative parameters such as first-day UCVA, number of eyes with microstriae, folds requiring stretching, or cases of diffuse lamellar keratitis did not differ significantly. Eyes with flap microstriae had a significantly deeper mean ablation (114.5 microm [range, 52-146 microm]) than eyes without any flap abnormalities (75.4 microm [39-120 microm]). No significant differences were found between the consecutive and simultaneous groups.


CONCLUSIONS
The majority of patients did not experience better postoperative comfort from the application of a BSCL. Only 27% of patients reported more comfort from postoperative BSCL use. The latter have better tear film characteristics and a history of less difficulty with contact lenses preoperatively. A BSCL does not protect from the occurrence of microstriae.
Sekundo
Walter
W
Department of Ophthalmology, Philipps University, Marburg, Germany. sekundo@med.uni-marburg.de
Dick
H Burkhard
HB
Meyer
Carsten H
CH
D000328:Adult; D001251:Astigmatism / Q000601:surgery*; D003263:Contact Lenses, Hydrophilic / Q000009:adverse effects; D003315:Cornea / Q000601:surgery; D005260:Female; D006801:Humans; D020731:Keratomileusis, Laser In Situ; D008297:Male; D009216:Myopia / Q000601:surgery*; D009779:Occlusive Dressings / Q000009:adverse effects; D010149:Postoperative Pain; D017060:Patient Satisfaction; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D011446:Prospective Studies; D014792:Visual Acuity; D014945:Wound Healing / Q000502:physiology*