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S. Quah, F. C. Figueiredo, M. Batterbury, S. B. Kaye; Comparison of Treatment Modalities for Symptomatic Bullous Keratopathy - A Randomised Prospective Study. Invest. Ophthalmol. Vis. Sci. 2007;48(13):4691.
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To study the efficacy of bandage contact lens (BCL), anterior stromal punctures (ASP) and amniotic transplantation (AMT) for pain relief for patient with painful bullous keratopathy (BK).
Randomised prospective study. Patients with a painful BK who had a poor visual potential were included. Patients were randomised to receive either BCL, ASP or AMT. In BCL group the patients received a 22mm hydrogel (Contaflex 75) BCL which was exchanged every 6 weeks. ASP was performed under topical anesthesia using a 25G stromal puncture needle. In the AMT group, croyopreserved amniotic membrane was sutured over the cornea following the debridement of the corneal epithelium using interrupted 10/0 nylon sutures under local anaesthesia. All patients in the study received a course of prednisolone 1% four times daily and chloramphenicol 0.5% four times daily for 7 days during the initiation of treatment. Visual analogue score for duration and severity of pain, grittiness and light sensitivity were recorded at baseline and repeated at 1 week, 1 month, 3 months, 6 months and 12 months.
Thirty three patients were recruited. Fourteen patients were excluded leaving a total of 19 patients who were randomised into the study. Six patients received BCL, 5 patients received ASP and 8 patients received AMT. Results from the first 6 months of study is presented. At baseline, there was no difference in the severity and duration of experienced by the patients in each treatment group. All patients experienced a significant reduction in the severity of the pain at 1 month (p=0.039), 3 months (p=0.01) and 6 months (p=0.043). There was no significant difference in the severity and duration of pain, grittiness and light sensitivity between patients receiving BCL, ASP or AMT at 1 week, 1 month, 3 months, 6 months (0.09<p<0.83). At 1 month, patients who received AMT were 1.5 times more likely to be pain free than patients who received BCL, and 1.7 times more likely to be pain free than patients who received ASP. One patient treated with BCL developed an infective corneal infiltrate requiring BCL removal and intensive topical antibiotics during the study.
We found no difference in the symtomatic relief of painful BK using BCL, ASP or AMT, that is all 3 treatments gave equivalent pain relief. Longer follow up is however, ongoing.
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