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Bandage contact lens after CXL increases keratitis risk

The use of bandage contact lenses and steroids immediately following epithelium-off corneal collagen cross-linking significantly increases the risk of microbial keratitis

Roibeard O’hEineachain

Posted: Saturday, February 10, 2018



Argyrios Tzamalis MD

The use of bandage contact lenses and steroids immediately following epithelium-off corneal collagen cross-linking significantly increases the risk of microbial keratitis and confers no benefit in terms of haze reduction, according to the results of a large cohort study, said Argyrios Tzamalis MD, UK.

“Our study identified the postoperative use of bandage contact lens and topical steroids before epithelial healing as main risk factors for the development of microbial keratitis after CXL,” Dr Tzamalis told the 22nd ESCRS Winter meeting.

The study involved 1,273 eyes of 964 patients who underwent collagen corneal cross-linking between February 2011 and July 2017 for the management of progressive keratoconus. Nine eyes of eight patients (0.71% of treated eyes) developed microbial keratitis one-to-five days after CXL. All had received bandage contact lenses at the conclusion of surgery in addition to topical steroids starting immediately postoperatively.

However, among 957 eyes where the postoperative treatment protocol was modified to exclude the use of bandage contact lens and topical steroids before complete epithelial healing, no further cases of microbial keratitis were detected. The difference between the two treatment groups in terms of the incidence of microbial keratitis was statistically significant difference (p<0.0001).

Dr Tzamalis noted that a greater proportion of patients developing microbial keratitis were atopic (75%). Staphylococcus aureus was the only pathogen identified, being isolated from the cornea in four patients, from the conjunctiva in two patients and the nose in three patients.


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