Proxymetacaine hydrochloride 0.5 eyedrops alcaine

Refraction was performed following the instillation of tropicamide drops (1%) in each eye, using a streak retinoscope. Pupillary dilation and the absence of a pupillary light reflex was considered as successful cycloplegia. The refraction examination was conducted independently by two experienced optometrists. Results with a discrepancy ≤0.5 D between the optometrists were considered valid, otherwise a third examination was required.
All measurements including lens fitting were performed 15 minutes after general anesthesia with an intra-muscular injection of pentobarbital sodium (10 mg/kg) and topical administration of proxymetacaine hydrochloride 0.5% eyedrops (Alcaine; Alcon Laboratories Inc, Fort Worth, TX).

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.

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.