Tobradex

All patients underwent uncomplicated cataract surgery by two experienced cataract surgeons (Y.Z.L. and W.R.C.). General anesthesia was administered prior to surgery. After a temporal clear corneal incision was made, DuoVisc and a soft-shell technique were used to reform and stabilize the anterior chamber and protect the corneal endothelium. A 5.5–6.0 mm central continuous curvilinear capsulorhexis was created using a bent 26-gauge disposable needle. Hydro-dissection was performed using a balanced salt solution, and a standard phacoemulsification was performed to completely remove the lens. A 3-piece monofocal acrylic IOL with a 6.5-mm optic diameter (Sensar AR40e, AMO, Inc. CA, USA) was placed via in-the-bag implantation following lens removal.
Postoperative topical therapy included the administration of 0.3 % tobramycin and 0.1 % dexamethasone eye drops (Tobradex, Alcon Laboratories, Inc, Texas, USA) four times per day and 0.3 % tobramycin and 0.1 % dexamethasone eye ointment (Tobradex, Alcon Laboratories, Inc, Texas, USA) every night for 1 month.

The postoperative care was similar for the four procedures. One drop of tobramycin/dexamethasone (Tobradex; Alcon, TX, United States) was instilled at the surgical site. A bandage contact lens (Acuvue Oasys; Johnson & Johnson, FL, United States) was then placed on the cornea and kept for 1 day in the FS-LASIK and FS-LASIK Xtra groups until complete re-epithelization in the tPRK and tPRK Xtra groups–typically between 5 and 7 days. Topical levofloxacin 0.5% (Cravit; Santen, Osaka, Japan) was used until the bandage lens was taken off. This was followed by application of fluorometholone 0.1% (Flumetholon; Santen, Osaka, Japan), topical levofloxacin 0.5% (Cravit; Santen, Osaka, Japan), and dexamethasone (Tobradex; Alcon, Rijksweg, Belgium) whose frequency, duration, and tapering regime varied between the procedures as shown in Figure 2.

Topical anesthesia, consisting of a single drop of 0.5% proparacaine (Alcaine, Alcon Laboratories), was administered three times at intervals of 5 minutes prior to surgery. After a temporal clear corneal incision was made, DuoVisc and a soft-shell technique were used to reform and stabilize the anterior chamber and to protect the corneal endothelium. A 5.5–6.0 mm central continuous curvilinear capsulorhexis was created with a bent 26-gauge disposable needle. Hydrodissection was carried out using balanced salt solution (BSS). In Group I, after a standard phaco-chop was performed to remove the lens nucleus completely, an IOL was implanted in the bag, and residual DuoVisc was removed by irrigation and aspiration. In Group II, the nucleus was divided into fragments using a standard phaco-chop. After most of the fragments were removed, the IOL was implanted in the bag before the residual fragment was removed (Figure 2).
No sutures were used to close the clear corneal incision. Postoperative topical therapy included 0.3% tobramycin and 0.1% dexamethasone eye drops (Tobradex, Alcon Laboratories) four times per day and 0.3% tobramycin and 0.1% dexamethasone eye ointment (Tobradex, Alcon Laboratories) every night for one month. All patients returned for follow up visits 1, 7 and 30 days after surgery.