Eyeworld

EW CATARACT 48 September 2011 by Maxine Lipner Senior EyeWorld Contributing Editor Options for providing comfort after cataract surgery T he ReSure Adherent Ocular Bandage (Ocular Therapeu- tix, Bedford, Mass.) can help to improve patient comfort after cataract surgery, ac- cording to Steven J. Dell, M.D., di- rector of refractive and corneal surgery, Texan Eye, Austin, Texas, and medical director, Dell Laser Con- sultants, Austin. Results published in the January issue of the Journal of Cataract & Refractive Surgery pegged the success of the hydrogel bandage at over 78% compared to 26.5% for the corneal shield (Oasis Medical Inc., Glendora, Calif.). Investigators set out to review outcomes with the new hydrogel bandage and see how they stacked up against those of the collagen shield. "The impetus behind the study was to determine whether the comfort that we could achieve with this ocular bandage was superior to the prior available device, which is a collagen shield, after cataract sur- gery," Dr. Dell said. "We wanted to know if these patients would be more comfortable if their wounds were covered by this product." The 388 patients included in the prospective, randomized study were slated to undergo cataract surgery with a clear corneal valve sutureless incision. "They were randomized to receive either the ocular bandage or to have a collagen shield placed at the conclusion of the case," Dr. Dell said. Heightened patient comfort Investigators found that patient comfort levels with the hydrogel bandage tended to be higher than with the shield. "The ocular bandage was found to be superior to the col- lagen shield in terms of patient com- fort," Dr. Dell said. Results indicated that 228 out of 290 patients who re- ceived the hydrogel bandage deemed the device a success com- pared with just 26 out of 98 who used the corneal shield. Outcomes were not entirely un- expected. "Collagen shields are an imperfect technology because they tend to break apart," Dr. Dell said. "They dissolve and fragment over a 24-hour period and that can be rela- tively uncomfortable for patients be- cause they have pieces of the collagen shield in their eye." This is not an issue with the hydrogel band- age. "The ocular bandage was by contrast very well tolerated and cov- ered the surgical wound completely with a smooth, uniform surface," Dr. Dell said. Because of its drawbacks, Dr. Dell sees the collagen shield as not particularly popular. "I think colla- gen shields are not widely used any more simply because we have better pharmaceuticals in terms of pain control post-op," he said. "The dis- advantages of a collagen shield breaking apart tend to outweigh the advantages." Terry Kim, M.D., professor of ophthalmology, Duke University School of Medicine, Duke University Eye Center, Durham, N.C., sees the collagen shield as a potential boon for assisting some patients with sur- face healing. "The benefit is, as op- posed to a contact lens, this is something that you can just pop into the eye, you can soak it with antibiotics, and it dissolves within 24 hours so you don't have to worry about taking it out," Dr. Kim said. "It's an alternative way of providing patients with a possible adjunct to surface healing or comfort with the added ability of being able to load it with antibiotic." It may also be use- ful in corneal transplant cases in- volving full epithelial defects. "The patient may have some discomfort and it may make sense to put a col- lagen shield on those patients," Dr. Kim said. Additional applications When it comes to the hydrogel bandage, there are other applica- tions not studied here that Dr. Dell views as potentially very attractive. "For example, this technology may be applicable as a wound sealant in that it might also have the ability to ReSure Bandage visible over CCI with fluorescein Source: ReSure Ocular Bandage US Pivotal Clinical Trial New adherent ocular bandage for clear corneal incisions in cataract surgery Source: Steven J. Dell, M.D.x

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