Comparison of the efficacy of lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy

Abstract

Background: At completion of transepithelial photorefractive keratectomy (t-PRK) surgery, the eye is usually fitted with a bandage contact lens to reduce discomfort and promote epithelial healing. This study aimed to compare the outcomes of eyes fitted with lotrafilcon B versus comfilcon A, silicone hydrogel bandage contact lenses after t-PRK for the correction of low to moderate myopia, with or without astigmatism.
 Methods: In this comparative, prospective study, patients with myopia < -6 D with or without astigmatism (< 1.75 D), who underwent t-PRK between January and June 2018, were randomly allocated to the lotrafilcon B and comfilcon A groups. Preoperative characteristics, including age, sex, eye treated, uncorrected visual acuity (UCVA), best-corrected visual acuity, mesopic pupil size, central corneal thickness, and refractive error were recorded. Postoperatively, pain score, UCVA, and corneal epithelial defect size on days 1, 4, and 7 were compared between the two groups.
 Results: Twenty-nine eyes were included in each group. Demographic characteristics and preoperative measurements were similar between the two groups. UCVA was significantly improved on day 7 as compared to day 1 in the comfilcon A group (P = 0.03), but remained the same in the lotrafilcon B group (P = 0.70) as on day 1 postoperatively. There was no significant difference in UCVA between the two groups at any follow-up visits (all P > 0.05). The pain score on the first postoperative day was significantly higher in the lotrafilcon B-fitted eyes than in the comfilcon A group (P < 0.001), but was significantly reduced in both groups compared to day 1 (both P < 0.001). The epithelial defect in the comfilcon A group was significantly greater than in the lotrafilcon B group (P < 0.001) at day 1 postoperatively, with significant improvement in both groups (both P < 0.001).
 Conclusions: Healing responses were better with lotrafilcon B than with comfilcon A bandage contact lenses. The patients had a greater mean pain score with lotrafilcon B than with comfilcon A lenses on the first postoperative day, yet the final outcome was comparable between the two groups. We did not encounter any postoperative complications related to contact lens wear.
 How to cite this article: Lotfy NM, Alasbali T, Alsharif AM, Al-Gehedan SM, Jastaneiah S, Al-Hazaimeh A, Ali H, Khandekar R. Comparison of the efficacy of lotrafilcon B and comfilcon A silicone hydrogel bandage contact lenses after transepithelial photorefractive keratectomy. Med Hypothesis Discov Innov Ophthalmol. 2021 Summer; 10(2): 1-7. https://doi.org/10.51329/mehdiophthal1420

Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review

“…In total, 11 RCTs and seven observational studies related to PRK surgeries were included in the study. 9,21,25,33–55 The follow-up duration varied from 3 days to 6 months. The BCL wear time after surgery varied from 3 days to 1 week.…”

“…46 Table S8, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the benefits associated with types of BCLs with limited studies focusing on long-term benefits. 9,21,25,33–55 Future clinical trials are warranted to understand the effect of BCLs on all visual outcomes associated with PRK.…”

“…9 Uncorrected visual acuity (UCVA) was improved considerably on the seventh postoperative day with BCL application. 43 The removal of BCL on the seventh postoperative day was beneficial compared with that on the fourth postoperative day 46 in visual rehabilitation (corrected distance visual acuity and uncorrected distance visual acuity; P¼0.016) after 1 month. A similar study showed that the removal of BCL on the third or fifth postoperative day yielded no significant benefits in visual acuity.…”

“…The studies reported uniform administration of postoperative medication regimens such as antibiotics, steroids (betamethasone, loteprednol, prednisolone, and fluorometholone), NSAIDs (diclofenac, nepafenac, and ketorolac), and opioids (in few studies) were applied to both eyes including control or between comparisons of BCLs eyes after PRK. [33][34][35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50] Among other outcomes, epiphora scores and comfort scores improved by day 3 after surgery on BCL application, whereas photophobia scores and foreign body sensation decreased by the third day after surgery. 35,37,42,54,55 Pain is known to subside when re-epithelialization of the cornea is completed.…”

Hydrogel for light delivery in biomedical applications

“…High water content in the hydrogels would allow the cornea to remain well hydrated, [ 154 ], which is a key factor that determines comfort level for the user. A well explored example would be Poly (2-hydroxyethyl methacrylate) (pHEMA)-based hydrogel [ 155 ] and silicone hydrogel [ 156 ] as medicated ophthalmic lenses. In addition to the previously mention characteristics, the polymeric matrix of the hydrogel can be employed to encapsulate drugs or therapeutic proteins and also act as the physical barrier to slow diffusion in order to achieve sustained and localised delivery of therapeutics [ 70 ].…”