Bandage Contact Lenses After Refractive Surgery

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Bandage Contact Lenses

Introduction

Bandage contact lenses are widely used in refractive surgery. The main purpose of this practice is to reduce inflammatory cell infiltration into the corneal stroma therefore decreasing the threat of corneal scarring. Also, bandage lenses assist in the regeneration of basement membrane and restoration of tight epithelial stromal adhesion. The bandage lens protects the loosely adherent and regenerating epithelium from the relentless action of the eyelids. In addition, the lens provides comfort without affecting the patient’s vision [16].

Use after Refractive Surgery

Surface Ablation

Immediately after surface ablation procedures such as LASEK or PRK, bandage contact lenses are routinely applied to patients’ eyes to encourage re-epithelialization and healing, and to reduce discomfort and pain [1, 2].

LASIK

Bandage contact lenses can be applied after LASIK [3], to reduce discomfort and prevent epithelial in-growth [4, 5]. However, some believe this actually increases the risk for striae[6], or may not have any beneficial effects [6, 7, 8]. Some patients are at risk of developing an epithelial slide, especially those with a history of anterior basement membrane dystrophy [9]. If an epithelial slide occurs during the operation, a bandage contact lens may be applied to the eye to improve healing and protect the eye until the epithelium has regrown [9].

Surgical Complications

Striae

Striae, or flap folds, are a complication of LASIK in up to 3.5% of cases [10]. The folds can disturb visual acuity, though often they resolve on their own [10]. Causes of striae include flap dessication, flap misalignment and flap tenting. Striae can be classified as macrostriae or microstriae, and the treatment for both groups can involve the use of bandage contact lenses.

Macrostriae are caused by flap dislocation and often involve the entire thickness of the flap. If the macrostriae are not detected early, the flap must be refloated and stretched again [11]. Different methods have been proposed for this procedure, but many involve the use of bandage contact lenses after completion to help the epithelium re-grow correctly [10, 12, 13].

Microstriae are smaller flap folds that are caused by problems in flap settling. These striae more often resolve on their own with the help of artificial tears and bandage contact lenses. However, if the striae persist, stretching or refloating of the flap may be necessary, and a bandage contact lens is used [10].

Epithelial In-growth

Epithelial in-growth is an infrequent complication of LASIK, that is caused either by implantation of epithelial cells during surgery or from epithelial cells growing underneath the flap [4]. Removal of the in-growth involves lifting the flap, irrigating the interface and subsequently placing a bandage contact lens [4]. This prevents epithelium from re-entering the flap interface.

Overcorrection

In cases of consecutive hyperopia, also known as overcorrection, bandage contact lenses may be used in conjunction with non-steroidal anti-inflammatory drugs (NSAIDs) to reduce the need for a second surgery. The contact lens helps increase the NSAIDs penetration into the cornea to stimulate stromal re-growth. The tight fit of the contact lens also creates a contour that helps correctly shape the growth [14].

Bandage Contact Lens Complications

In some cases, bandage contact lenses can lead to infectious keratitis.[15]. Other complications can include dry eye, corneal hypoxia, and corneal edema. Patients should be aware of proper lens hygiene.

1. Gil-Cazorla R, Teus MA, Hernández-Verdejo JL, De Benito-Llopis L, García-González M. Comparative study of two silicone hydrogel contact lenses used as bandage contact lenses after LASEK. Optom Vis Sci 2008; 85(9):884-8. 2. Szaflik JP, Ambroziak AM, Szaflik J. Therapeutic use of a lotrafilcon A silicone hydrogel soft contact lens as a bandage after LASEK surgery. Eye Contact Lens 2004; 30(1):59-62. 3. Lam DS, Leung AT, Wu JT, Cheng AC, Fan DS, Rao SK, Talamo JH, Barraquer C. Management of severe flap wrinkling or dislodgment after laser in situ keratomileusis. J Cataract Refract Surg 1999; 25(11):1441-7. 4. Asano-Kato N, Toda I, Hori-Komai Y, Takano Y, Tsubota K. Epithelial ingrowth after laser in situ keratomileusis: clinical features and possible mechanisms. Am J Ophthalmol 2002;134(6):801-7. 5. Walker MB, Wilson SE. Incidence and prevention of epithelial growth within the interface after laser in situ keratomileusis. Cornea 2000; 19(2):170-3. 6. Montes M, Chayet AS, Castellanos A, Robledo N. Use of bandage contact lenses after laser in situ keratomileusis. J Refract Surg 1997; 13(5 Suppl):S430-1. 7. Ahmed IK, Breslin CW. Role of the bandage soft contact lens in the postoperative laser in situ keratomileusis patient. J Cataract Refract Surg 2001; 27(12):1932-6. 8. Sekundo W, Dick HB, Meyer CH. Benefits and side effects of bandage soft contact lens application after LASIK: a prospective randomized study. Ophthalmology 2005; 112(12):2180-3. 9. Dastgheib KA, Clinch TE, Manche EE, Hersh P, Ramsey J. Sloughing of corneal epithelium and wound healing complications associated with laser in situ keratomileusis in patients with epithelial basement membrane dystrophy. Am J Ophthalmol 2000; 130(3):297-303. 10. von Kulajta P, Stark WJ, O'Brien TP. Management of flap striae. Int Ophthalmol Clin 2000; 40(3):87-92. 11. Gimbel HV, Penno EE, van Westenbrugge JA, Ferensowicz M, Furlong MT. Incidence and management of intraoperative and early postoperative complications in 1000 consecutive laser in situ keratomileusis cases. Ophthalmology 1998; 105(10):1839-48. 12. Pannu JS. Incidence and treatment of wrinkled corneal flap following LASIK. J Cataract Refract Surg 1997; 23(5):695-6. 13. Jackson DW, Hamill MB, Koch DD. Laser in situ keratomileusis flap suturing to treat recalcitrant flap striae. J Cataract Refract Surg 2003; 29(2):264-9. 14. McDonald JE 2nd, Mertins A, Deitz D. Contact lens assisted pharmacologically induced keratoshaping. Eye Contact Lens 2004; 30(3):122-6. 15. Schein OD, Buehler PO, Stamler JF, Verdier DD, Katz J. The impact of overnight wear on the risk of contact lens-associated ulcerative keratitis. Arch Ophthalmol 1994; 112(2):186-90. 16. Sutphin Jr. JE et al. External Disease and Cornea. San Francisco. AAO, 2008

Original article contributed by: User:David Rubins MS1, Anjali K. Pathak, M.D.
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