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

“

TL;DR

This systematic review of 38 studies (14,759 patients) found that bandage contact lenses (BCLs) effectively reduce postoperative pain, promote corneal re-epithelialization, and improve dry eye symptoms after various ocular surgeries including PRK, cataract, and vitrectomy. Optimal wear time varies by surgery type, ranging from 8 hours (SMILE) to 7 days (PRK, cataract, LASIK, vitrectomy). The findings support BCL use as a standard postoperative measure to enhance patient comfort and visual rehabilitation.

Full summary

3,190 CHARS

**Background:** Postoperative complications such as pain, dry eye discomfort, and delayed visual rehabilitation are common after ocular surgeries. Bandage contact lenses (BCLs) are hydrogel lenses used to protect the corneal surface, promote re-epithelialization, and reduce symptoms. However, evidence on the optimal BCL material and wear time for different surgeries was lacking. This systematic review aimed to evaluate the performance of five silicone hydrogel BCL materials (lotrafilcon A, lotrafilcon B, balafilcon A, comfilcon A, senofilcon A) after various ocular surgeries.

**Methods:** The review followed PRISMA guidelines and was registered in PROSPERO (CRD42022366437). English and Chinese databases were searched from inception to December 2021. Two independent reviewers selected studies and extracted data. Quality was assessed using the JADAD scale for RCTs and the Newcastle–Ottawa scale for observational studies.

**Key Results:** Of 12,836 articles, 38 met inclusion criteria, comprising 14,759 patients aged ≥18 years. Studies covered corneal refractive surgery (n=26), cataract surgery (n=5), corneal cross-linking (CXL) surgery (n=2), and vitrectomy (n=5). Follow-up ranged from 3 days to 6 months. Quality was moderate in 68.4% of studies.

- **PRK (18 studies):** BCLs reduced pain significantly by postoperative day 3, with negligible pain by day 4. Complete re-epithelialization occurred in 72.7%–83% of eyes within 3.1–3.6 days. Exchanging BCL daily lowered pain on day 1 (P=0.009). Removal on day 7 improved visual acuity at 1 month vs. day 4 (P=0.016). Epithelial defect size decreased markedly from day 1 to day 3. - **LASEK (2 studies):** Balafilcon A reduced symptoms (P<0.05) and shortened healing time (4.07±0.25 vs. 4.33±0.82 days). - **LASIK (5 studies):** BCLs reduced pain (P=0.04) and photophobia (P=0.003), and improved fibrotic healing (P<0.001) at 6 months. Seven-day wear improved epithelial healing. - **SMILE (1 study):** Senofilcon A reduced symptom scores at 2 hours (P=0.012 and P=0.020) vs. no BCL. - **Cataract (6 studies):** BCLs improved Ocular Surface Disease Index scores at 1 week (P<0.001) and 14 days (P<0.001). Tear break-up time and fluorescein staining improved at 1 week (P=0.021 and P=0.03) and 14 days (P=0.021 and P=0.032). Pain improved within 8 hours (P<0.05) and at 3 days (P<0.05). - **CXL (2 studies):** Pain scores decreased from day 1 (4.61±2.3 and 4.06±2.2) to day 3 (0.91±1.43 and 4.06±2.2). Re-epithelialization completed in 3 days. - **Vitrectomy (5 studies):** Corneal fluorescein staining score was lower with BCL on day 1 (0.61±0.62 vs. 1.81±1.26, P=0.003). Ocular irritation and pain improved by day 7 (P<0.05). Epithelial defect improved by day 14 (P=0.0002).

**Clinical Implications:** BCLs are effective postoperative bandages for corneal refractive, cataract, CXL, and vitrectomy surgeries, providing pain relief, promoting re-epithelialization, and improving dry eye symptoms. Optimal wear time varies: 8 hours for SMILE, 3–7 days for PRK and cataract, 7 days for LASIK and vitrectomy, and 3 days for CXL. Clinicians should tailor BCL wear time to surgery type and patient profile to maximize benefits.