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.
Flarex
Manufactured by Alcon
Sourced in United States, Canada
Flarex is a sterile ophthalmic suspension. The active ingredient is fluorometholone acetate, a corticosteroid.
Automatically generated - may contain errors
5 protocols using flarex
1
Post-Surgical Corneal Care Protocol
2
Tecnis Symfony IOL Implantation Protocol
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All cataract surgeries were performed by a single surgeon (M.K.K.). After the conventional phacoemulsification through the temporal clear corneal incision, TECNIS® Symfony or TECNIS® Symfony Toric IOLs were implanted in the capsular bag. Postoperatively, topical fluorometholone acetate ophthalmic suspension (Flarex®, Alcon, Alcon Laboratories Inc., Fort Worth, TX, USA) were administered four times a day for 1 week, topical levofloxacin 0.5% (Cravit®, Santen Pharmaceutical, Osaka, Japan) eye drops were administered four times a day for 1 month, and topical bromfenac sodium ophthalmic solution 0.1% (Bronuck®, Taejoon Pharm, Seoul, Korea) was instilled twice a day for 2 months.
3
Corneal Cross-Linking: A Step-by-Step Procedure
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CXL was performed under sterile conditions in the operating room. After applying topical anesthesia with proxymetacaine hydrochloride (0.5%) eye-drops (Alcaine, Alcon Co. Inc., Canada), the corneal epithelium was removed with a blunt spatula (8.0–9.0 mm diameter). Riboflavin (0.1% solution VibeX; Avedro Inc., Waltham, MA) was instilled at the center of the cornea for 15 min (one drop every 2 min). The cornea was exposed to 365 nm UVA light with the CXL system (Avedro Inc., Boston, USA) for 4 min at an irradiance level of 30 mW/cm2 (total surface dose, 7.2 J/cm2). A soft contact lens with a 14.0 mm diameter, 8.6 base curvature, and oxygen permeability of 140 barrers (lotrafilcon B [Air Optix], Alcon Laboratories Inc.) was applied at the end of the procedure. Postoperatively, moxifloxacin (0.5%, Vigamox, Alcon, Inc. Canada) was applied 4 times per day for 1 week, and artificial tears were administered 4 times per day for 1 month, at which point the soft contact lenses were removed. Patients received fluorometholone acetate (0.1%, Flarex, Alcon Inc., Canada) 4 times per day, which was tapered down over 2 weeks after removal of the soft contact lens. All patients were followed up daily until the epithelium healed.
4
Corneal Cross-Linking Procedure Protocol
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After applying topical anesthesia of proxymetacaine hydrochloride 0.5% eye drops (Alcaine, Alcon, Co., Inc., Canada), the corneal epithelium was removed with a blunt spatula (8.0 to 9.0 mm diameter). Single-use isotonic eye drops of riboflavin 0.1% and 20% dextran solution (Medio Cross D; Peschke Meditrade GmbH, Huenenberg, Switzerland) was instilled on the center of the cornea every 2 minutes for approximately 20 minutes in group 1 and 30 minutes in group 2. Ultraviolet-A irradiation was performed using high-intensity UVA illuminator (Peschke CCL-VARIO Meditrade GmbH) with an intended irradiance of 18.0 mW/cm2 (total surface dose of 5.4 J/cm2) for 5 minutes in both groups. The device has 1 diode (365 nm) and special optics with high homogeneity and illumination stability over a wide range. Beam intensity and beam diameter (approximately 11 mm) are stabilized at 50 ± 5 mm from the beam aperture. At the end of the procedure, a silicone-hydrogel bandage contact lens was placed and it remained until full reepithelization (postoperative 3-4 days). Postoperative medication included moxifloxacin 0.5% (Vigamox, Alcon, Inc., Canada) 4 times a day for one week and artificial tears 4 times a day for one month postoperatively. After removal of the contact lens, patients received fluorometholone acetate 0.1% (Flarex, Alcon, Inc., Canada) 4 times a day which was tapered over 2 weeks.
5
Cataract Surgery with Multifocal IOLs
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Two surgeons (MKK and JYH) performed all cataract surgeries by standard phacoemulsification with IOL implantation using the same measurement and surgical instruments. Surgical procedures were performed with an on-astigmatic axis clear corneal incision. Eye drops with 0.5% levofloxacin (Cravit; Santen, Osaka, Japan) and 0.1% fluorometholone (Flarex; Alcon Laboratories, Fort Worth, TX, USA) were instilled four times daily for 4 weeks. Follow-up examinations were performed at 1 day, 1 week, and 1 month after surgery.
AT LISA tri 839MP (Carl Zeiss Meditec, add power +3.33 D/+1.66 D), AcrySof IQ ReSTOR SN6AD1, or SND1T# (Alcon Laboratories, add power +3.0 D), or Tecnis MF ZLB00 (Abbott Medical Optics, Abbott Park, IL, USA; add power +3.25 D) IOLs were implanted.
AT LISA tri 839MP (Carl Zeiss Meditec, add power +3.33 D/+1.66 D), AcrySof IQ ReSTOR SN6AD1, or SND1T# (Alcon Laboratories, add power +3.0 D), or Tecnis MF ZLB00 (Abbott Medical Optics, Abbott Park, IL, USA; add power +3.25 D) IOLs were implanted.
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