The Ophthalmic Office Procedures Handbook

SECTION 5 Cornea and Conjunctiva

462

■ Topical steroid drops (e.g., prednisolone acetate 1% ophthalmic suspension or lotepre dnol 0.5% ophthalmic solution) TID (unless concern for infection or corneal melting) ■ Taper steroids over 3 weeks after fully epithelialized ■ Preservative-free lubrication drops every 2 to 3 hours ■ Pain medication (orals)—for example, tramadol hydrochloride 50 mg tablets every 6 to 8 hours as needed. Proper prescribing protocols must be followed. ■ Recommended follow-up schedule: ■ Every few days until fully re-epithelialized, then every 1 to 2 weeks for stability ■ 1, 4, then at 8 weeks During postoperative follow-up, tissue healing should be carefully monitored, and treat ment should be adjusted accordingly. It is very common to have medication changes according to treatment response. For example, if significant corneal haze is developing, topical ophthal mic steroids can be increased to 6 × /day for 2 days and then back to 4 × /day for the first week. If a cryopreserved AM is used, a topical steroid may not be necessary. However, if a dehydrated AM with a BCL is used, then a topical ophthalmic steroid is still recommended to prevent hypoxia-induced corneal infiltrates. If corneal tissue healing seems delayed or poor, consider decreasing the topical ophthal mic steroids to 2 × /day and adding topical ophthalmic cyclosporine. Certain advanced dry eye disease medications such as autologous serum eye drops or plasma-rich plasma drops, for example, could be continued if tissue healing is poor. Studies have reported that 81% of patients are typically fully epithelialized at the 1-week postoperative visit. 1 Patients should be made aware that vision will be blurred during heal ing and that significant ocular pain is expected for the first 1 to 3 days. Patients should also be advised to stay out of dry and/or dusty environments and consider refrigerating their preservative-free lubrication drops for comfort. POTENTIAL COMPLICATIONS AND THEIR TREATMENTS

Key Potential Complications ■ Corneal haze ■ Ocular pain ■ Delayed epithelial healing ■ Microbial keratitis (rare)

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Corneal haze is the most common complication, reported in up to 26% of cases of corneal debridement with diamond burr polish. Without diamond burr polishing, corneal haze was reported in up to 35% of cases. However, the level at which corneal haze is considered visually