After surgery, a bandage contact lens (Acuvue Oasys with hydraclear plus; Johnson & Johnson, Jacksonville, FL, USA) was used to protect the wound until all epithelial defects of the cornea were healed. Over the month following surgery, all patients received either topical 0.5% moxifloxacin hydrochloride (Vigamox, Alcon) or 0.3% gatifloxacin hydrochloride (Gatiflox; Handok, Seoul, Korea) four times a day, along with 0.5% loteprednol suspension (Lotemax; Bausch & Lomb, Tampa, FL, USA) or 0.1% fluorometholone acetate solution (Flarex, Alcon) on the same schedule, and autologous serum eye drops (prepared in the institutional blood bank as described in the literature)2019-02-11 [20 (link)] every 2 hours. Thereafter, topical steroid- and autologous serum-use were tapered off based on the status of the ocular surface. The first week following surgery, patients were prescribed 30 mg of oral prednisolone a day, which was tapered off to 20 mg a day for the second week and 10 mg a day for the third week. Patients were additionally encouraged to gargle with 5% chlorohexidine solution four times a day to aid the healing of the oral mucosa. Preservative-free artificial tears were also prescribed.
Lotemax
Manufactured by Bausch & Lomb
Sourced in United States, United Kingdom
Lotemax is a prescription eye drop medication manufactured by Bausch & Lomb. It contains the active ingredient loteprednol etabonate, a corticosteroid used to treat inflammation of the eye.
Automatically generated - may contain errors
Lab products found in correlation
Vigamox, by Alcon (4 mentions)
Cravit, by Santen (2 mentions)
Alcaine, by Alcon (2 mentions)
Alphagan p, by Abbvie (2 mentions)
Mydrin p, by Santen (2 mentions)
Flarex, by Alcon (1 mentions)
Pred forte, by Abbvie (1 mentions)
Mydriacyl, by Novartis (1 mentions)
Refresh tear, by Abbvie (1 mentions)
Ikervis, by Santen (1 mentions)
Diquas, by Santen (1 mentions)
Levofloxacin, by Santen (1 mentions)
Duratears, by Alcon (1 mentions)
Maxidex, by Alcon (1 mentions)
Restasis, by Abbvie (1 mentions)
Flumetholon, by Santen (1 mentions)
Healon, by Abbott (1 mentions)
11 protocols using lotemax
1
Post-Surgical Corneal Care Protocol
2
Penetrating Keratoplasty Surgical Technique
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PKP was performed by a single experienced surgeon (T.I.K.) following standardized procedures under general anesthesia. The recipient cornea trephination diameter was 7 to 8 mm and the donor corneal diameter was the same or 0.25 mm larger than that of the recipient’s. The graft was sutured to the recipient bed with 16 interrupted 10–0 nylon sutures. At the end of the surgery, intraoperative adjustment of sutures was performed to minimize the risk of corneal astigmatism. Pressure patch was applied for 3 to 5 days until epithelial defects are healed.
Postoperatively, topical 0.5% levofloxacin (Cravit, Santen Pharmaceutical, Osaka, Japan) and topical 1% prednisolone acetate (PredForte, Allergan, Irvine, California) were applied four times a day. Topical antibiotics were gradually tapered and maintained for 1 year. Topical steroids were also tapered and maintained for 2 years. Increased intraocular pressure was managed with glaucoma medication and topical 1% prednisolone was switched to topical 0.5% loteprednol (Lotemax, Bausch & Lomb, Rochester, New York) in each patient as needed. Patients were instructed to use 0.1% hyaluronic acid artificial tears for dry eye management, as necessary.
Postoperatively, topical 0.5% levofloxacin (Cravit, Santen Pharmaceutical, Osaka, Japan) and topical 1% prednisolone acetate (PredForte, Allergan, Irvine, California) were applied four times a day. Topical antibiotics were gradually tapered and maintained for 1 year. Topical steroids were also tapered and maintained for 2 years. Increased intraocular pressure was managed with glaucoma medication and topical 1% prednisolone was switched to topical 0.5% loteprednol (Lotemax, Bausch & Lomb, Rochester, New York) in each patient as needed. Patients were instructed to use 0.1% hyaluronic acid artificial tears for dry eye management, as necessary.
3
Accelerated Corneal Cross-Linking Protocol
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Accelerated CXL has been performed on all patients. Initially, a topical anesthetic agent, proparacaine 0.5%, (Alcaine; Alcon Laboratories, Inc.) was administered and 8 mm central corneal epithelium was removed with a blunt spatula. Riboflavin with dextran (0.1% riboflavin in 20% dextran, Medicross, Germany) solution was then administered topically every two minutes for 20 min in both groups. After the installation of the riboflavin as a photosensitizer, the cornea was exposed to a UV-A 365 nm light for five minutes at an irradiance of 18 mW/cm2 in Group 1 and 10 min at an irradiance of 9 mW/cm2 in Group 2 (Peschke Meditrade, GmbH, Switzerland). Riboflavin was instilled every minute during the UV-A exposure in Group 1 and every two minutes in Group 2. After treatment, the eye surface was washed with 20 mL of a balanced salt solution, medicated with antibiotic eye drops (moxifloxacin 0.5%, Vigamoxª; Alcon Co., Inc.) and dressed with a bandage soft contact lens until the closure of epithelial defect. Topical moxifloxacin eye drops (four times per day for one week; Vigamox; Alcon Co., Inc.), artificial tears (four times per day for one month) and loteprednol etabonate ophthalmic suspension 0.5% (four times per day two weeks after epithelial healing; Lotemax; Bausch & Lomb) were administered postoperatively.
4
Accelerated Corneal Crosslinking Protocol
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Accelerated crosslinking has been performed to all patients. Initially, a topical anesthetic agent (Alcaine; Alcon Laboratories, Inc.) was administered and the central 8.0 mm epithelium was removed with a blunt spatula. Riboflavin with dextran (0.1% in 20% dextran solution, Medicross, Germany) was administered topically every three minutes for 30 minutes. The cornea was aligned and exposed to UV-A 365 nm light for five minutes at an irradiance of 18 mW/cm2 (Peschke Meditrade, GmbH) (11 (link)). During UV-A exposure, riboflavin administration was continued every minute. After the treatment, the eye surface was washed with 20.0 mL of a balanced salt solution. Postoperatively, antibiotic (Vigamox; Alcon Co., Inc.), corticosteroid drops (Lotemax; Bausch & Lomb) and artificial tears (Refresh; Allergan) were administered; a soft contact lens bandage was placed. The contact lens was removed after the closure of the epithelial defect. Antibiotics and corticosteroid drops were continued four times daily for one week and two weeks, respectively.
5
Evaluating MMP-9 Immunoassay Interference in Eye Drops
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To investigate interactions between the MMP-9 immunoassay and components within eye drops, 10 μl of rhMMP-9 (200 ng/ml) was applied to the sample collector, followed by addition of 10 μl of eye drop sample. The following eye drops were used: Elazop (brinzolamide/timolol; Novartis, Basel, Switzerland), Alphagan-P (brimonidine tartrate 0.15%; Allergan, Dublin, Ireland), Isopto Carpine (pilocarpine hydrochloride 2%; Novartis), Bronuck (bromfenac sodium 0.1%; TaeJoon, Seoul, Korea), Cravit (levofloxacin 0.5%; Santen, Tokyo, Japan), Diquas (Diquafosol sodium 3%; Santen), Ikervis (cyclosporine A cationic emulsion 0.1%; Santen, Evry, France), Lotemax (loteprednol etabonate 0.5%; Bausch & Lomb, Rochester, NY, USA), Pazeo (olopatadine hydrochloride 0.7%; Novartis), Lastacaft (alcaftadine 0.25%; Allergan), Mydrin-P (tropicamide 0.5%/phenylephrine 0.5%; Santen), Mydriacyl (tropicamide 1%; Novartis), Cyclogyl (cyclopentolate HCl 1%; Norvatis), Isopto Atropine (atropine hydrochloride 1%; Novartis), and Refresh Tears (carboxymethylcellulose sodium 0.5%; Allergan). The test line was photographed after 10 and 20 min, the density was measured, and the results were compared with a control sample (200 ng/ml of rhMMP-9; 20 μl).
6
Treatment Regimen for Recalcitrant PEDs
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After the diagnosis of PEDs, all patients were instructed to instill preservative-free sodium hyaluronate 0.15% (Hyaluni eye drops 0.15%®, Taejoon Pharmaceutical Co., Ltd., Seoul, Korea) ≥6 times a day, levofloxacin 0.5% (Cravit®, Santen, Tokyo, Japan) 2–4 times a day, and lubricant ointment (Duratears®, Alcon Laboratories, Inc., Fort Worth, TX, USA) nightly as conventional therapy. Loteprednol 5% (Lotemax®, Bausch & Lomb, New York, NY, USA) was added when there was inflammation of the ocular surface. In addition, recombinant human EGF ointment (1 μg/g; Easyef® ointment, Daewoong Pharmaceutical Co., Ltd., Seoul, Korea) was applied to the lower conjunctival fornix twice a day in the eyes of patients with refractory PEDs undergoing conventional therapy.
7
Postoperative Management of Keratoplasty Patients
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Standardized eye examinations were conducted preoperatively and at 1 day, 1 week, and 1, 3, 6, 12, 24, and 36 months postoperatively and thereafter, following the standard care protocol of our clinic for keratoplasty patients. All eyes were treated with 0.5% moxifloxacin hydrochloride (Vigamox ® ; Alcon Pharma GmbH, Freiburg, Germany) and 0.1% dexamethasone (Maxidex®; Alcon Pharma GmbH) five times daily after surgery. The topical antibiotic was discontinued after 10 days. Dexamethasone was replaced with 0.5% loteprednol etabonate (Lotemax ® ; Bausch & Lomb, Bridgewater, NJ, USA) four times daily by 3-6 months after PK and 3 months after DALK. Topical steroid therapy was continuously administered for at least 18 months and a maximum of 2 years following PK, and for at least 12 months and a maximum of 18 months following DALK, which was gradually reduced to at least once a day according to patient's clinical outcomes.
The postoperative corneal astigmatism was followed up with topography (Sirius Scheimpflug-Placido topographer; Costruzione Strumenti Oftalmici, Florence, Italy). To reduce postoperative RA values and improve BCVA, selective suture removal was performed based on topographic maps. Antibiotic eye drops were used for 10 days after suture removal.
The postoperative corneal astigmatism was followed up with topography (Sirius Scheimpflug-Placido topographer; Costruzione Strumenti Oftalmici, Florence, Italy). To reduce postoperative RA values and improve BCVA, selective suture removal was performed based on topographic maps. Antibiotic eye drops were used for 10 days after suture removal.
8
Laser Peripheral Iridotomy Protocol
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After obtaining an informed consent for the procedure, all the subjects were administered topical pilocarpine 2% (Pilosed, Bilim Ilac, Turkey) to constrict the pupil. Brimonidine 0.15% (Alphagan P, Allergan, Ireland) was instilled before the procedure. Laser peripheral iridotomy was performed using Neodymiumdoped Yttrium Aluminium Garnet laser by a glaucoma specialist with Abraham peripheral iridotomy contact lens (Ocular Instruments, Bellevue, WA, USA), in the superior region (from 10 to 2 o'clock), aiming for iris crypts and for a minimum iridotomy size of 150-200 µm. Argon settings of 500 to 1000 mW power with a spot size of 50 µm for a duration of 0.05 seconds and a yttrium-aluminum-garnet setting of 2 to 5 mJ were used. One hour after iridotomy, patency of iridotomy was con rmed by retroillumination and direct visualization on slit-lamp biomicroscopy. Postoperative topical brimonidine 0.15% (Alphagan-P, Allergan, Ireland) and loteprednol (Lotemax, Bausch & Lomb, Inc.) were prescribed.
9
Multimodal Treatment Approach for Ocular Discomfort
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At the first visit, all patients were instructed to instill preservative-free sodium hyaluronate 0.15% (Hyaluni eye drops 0.15%®, Taejoon Pharmaceutical Co., Ltd., Seoul, Korea) 6 times a day, and loteprednol 0.5% (Lotemax®, Bausch & Lomb, Rochester, NY, USA) and cyclosporin A ophthalmic nanoemulsion 0.05% (Cyporin N®, Taejoon, Seoul, Korea) twice a day. After 1 month of treatment, an add-on of gabapentin 600 to 1200 mg/day (Neurontin cap®, Pfizer, New York, NY, USA) was determined according to the WBFPS score. The topical treatment was continued without gabapentin if the WBFPS score decreased by more than 2 points. If not, the add-on gabapentin treatment was administered for 1 month.
Patients were divided into three groups according to the treatment response: group 1 comprised patients who experienced symptomatic relief only with eye drops (topical treatment response group, n = 11); group 2 comprised patients who experienced symptomatic relief after the administration of gabapentin (gabapentin response group, n = 13); and group 3 comprised patients who were unresponsive to both treatments (gabapentin non-response group, n = 11;Figure 1 ).
Patients were divided into three groups according to the treatment response: group 1 comprised patients who experienced symptomatic relief only with eye drops (topical treatment response group, n = 11); group 2 comprised patients who experienced symptomatic relief after the administration of gabapentin (gabapentin response group, n = 13); and group 3 comprised patients who were unresponsive to both treatments (gabapentin non-response group, n = 11;
10
Moxifloxacin, Loteprednol, and Cyclosporine in Ocular Surface Regeneration
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Patients were treated daily with a combination of preservative-free drops of moxifloxacin (0.5%) (Vigamox®, Alcon, USA), 1% loteprednol etabonate (Lotemax®, Bausch &Lomb, U.K) and artificial tears. Moxifloxacin was stopped 10 days after the surgery and loteprednol was tapered slowly in 3 months according to the severity of ocular surface inflammation. Once the overlaying hAM waned away cyclosporine eye drops (Restasis®, Allergan, USA) were added to reduce the risk of dry eye-related inflammation. Topical artificial tear and cyclosporine treatment were continued for the duration of the study. Donor and recipient eyes were examined after 1, 3, 5, 7, 14 and 30 days and 2, 3, 6 and 12 months. Extra visits were performed in case of clinical need. Bio-microscopic anterior segment photographs were taken at each visit. The parametric test values described below were collected Preop and at the 1, 3, 6 and 12-month Postop visits.
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