Bandage Contact Lenses After Refractive Surgery
Assigned status Update Pending by Natalie Afshari, MD FACS on January 19, 2015.
Bandage Contact Lenses
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 
Use after Refractive Surgery
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  .
Bandage contact lenses can be applied after LASIK , to reduce discomfort and prevent epithelial in-growth  . However, some believe this actually increases the risk for striae, or may not have any beneficial effects  . Some patients are at risk of developing an epithelial slide, especially those with a history of anterior basement membrane dystrophy . 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 .
Striae, or flap folds, are a complication of LASIK in up to 3.5% of cases . The folds can disturb visual acuity, though often they resolve on their own . 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 . 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  .
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 .
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 . Removal of the in-growth involves lifting the flap, irrigating the interface and subsequently placing a bandage contact lens . This prevents epithelium from re-entering the flap interface.
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 .
Bandage Contact Lens Complications
In some cases, bandage contact lenses can lead to infectious keratitis.. Other complications can include dry eye, corneal hypoxia, and corneal edema. Patients should be aware of proper lens hygiene.
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