Hindawi

Journal of Ophthalmology
Volume 2021, Article ID 2873543, 9 pages
https://doi.org/10.1155/2021/2873543

Research Article
Comparative Evaluation of Bandage Contact Lenses and Eye
Patching after Bilateral Cataract Surgery

Dalan Jing,1,2 Aihua Deng,3 Hongmei Wang,1,2 Yilin Chou,1,2 Xiaodan Jiang,1,2
Zhenxiang Chen,3 Xuemin Li ,1,2 and Tingyi Wen 3
1
Department of Ophthalmology, Peking University Third Hospital, Beijing, China
2
Beijing Key Laboratory of Restoration of Damaged Ocular Nerve, Peking University Third Hospital, Beijing, China
3
CAS Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences,
Beijing, China

Correspondence should be addressed to Xuemin Li; lxmlxm66@sina.com and Tingyi Wen; wenty@im.ac.cn

Received 9 May 2021; Accepted 5 August 2021; Published 13 August 2021

Academic Editor: Giovanni William Oliverio

Copyright © 2021 Dalan Jing et al. This is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Purpose. To comparatively evaluate the safety and satisfaction of bandage contact lens (BCL) and eye patching in patients after
cataract surgery. Methods. Sixteen (32 eyes) patients who planned to undergo bilateral cataract surgery were recruited. The two
eyes of each patient were randomly divided into 2 groups. Group A and Group B were instructed to wear BCLs immediately at the
end of the surgery until one week and eye patch immediately after surgery until one day, respectively. Visual analog scales of ten
specific symptoms, Visual Function Index (VF-14) questionnaire, and best-corrected visual acuity (BCVA) were conducted on the
first day before the surgery and Day 1 and Day 7 after surgery. Oculus keratography was conducted on the first day before surgery
and on Day 7. Patient satisfaction was determined on Day 1. Moreover, bacterial species in the conjunctival sac, meibomian gland
secretions, and BCLs were subsequently identified using 16S rRNA gene sequencing. Results. The patient satisfaction scores of
Group A were higher than Group B. Group A were more motivated to choose the same treatment and were more likely to
recommend BCLs to others. No statistically significant differences were found in bacterial culture positivity between the groups.
The differences in ocular signs and symptoms between the two groups were not statistically significant. There were no significant
differences in the BCVA and VF-14 between the groups at any time point. Conclusions. BCLs could be safely and effectively used in
patients after cataract surgery.

1. Introduction patients is of particular importance especially for the fellow

eye of blind or poor visual acuity.
Phacoemulsification shows significantly improved visual Bandage contact lenses (BCLs) are widely used for
acuity for patients with cataract. Today the routine post- corneal diseases (corneal lesions, corneal refractive surgery,
operative management is wearing an eye patch overnight, and corneal transplantation) to reduce pain, provide me-
which has been considered as an efficient method for pre- chanical and structural protection, promote epithelial
venting infection. Unfortunately, it is associated with in- healing, and accelerate visual rehabilitation [3–6]. BCLs may
convenience and even injury by monocular vision and prolong drug release and retention towards the post-lens
stereopsis defects [1]. In addition, eye patching after cataract tear fluid, which could be useful in the treatment of ocular
surgery did not reduce postoperative discomfort and in- surface disease. [7].
flammation compared to “instant vision” without patching. However, contact lenses provide a suitable substratum
[2] A trend towards no patching cataract surgery was ob- for bacterial adherence which might lead to contact-lens-
served especially with modern surgical technologic im- related infections; [8] the lens also limits the tear fluid ex-
provements. The “instant vision” obtained for postoperative change that reduces antimicrobial tear fluid perfusion [9].
2 Journal of Ophthalmology

The clinical safety of BCLs remains controversial [10–12], divided randomly into two groups. Povidone-iodine (PI) 5%
and additional studies are required to better evaluate the solution was instilled before and after placement of the lid
BCLs. Hence, a subsequent paired comparison was per- speculum. All underwent standard phacoemulsification
formed to evaluate the safety and satisfaction of BCLs. through a 3.2 mm clear corneal incision and intraocular lens
implantation by the same surgeon (LXM). After surgery,
2. Materials and Method patients were instructed to wear BCLs made of balafilcon A
(water content 36%; extended wear; Pure Vision; Baus-
2.1. Participants. This study was conducted according to the ch&Lomb Inc, Rochester, NY) for a week, did not receive
principles of the Declaration of Helsinki and was approved any antibiotic ointments when the surgery was over (Day 0),
by the Human Research and Ethics Committee of Peking and were prescribed antibiotic eyedrops for a month from
University Third Hospital (16-08-QX-YK). Written in- Day 0. Group B received antibiotic ointment at Day 0, then
formed consent in Chinese was obtained from each par- were instructed to wear the eye patch, and were given an-
ticipant before recruitment. tibiotic eyedrops for a month from Day 1.
In this prospective clinical study, 16 (32 eyes) patients
with bilateral age-related cataract who were willing to un-
dergo outpatient phacoemulsification and intraocular lens 2.4. Samples Collection. Preoperative samples were collected
implantation surgery within one week were recruited. Be- in a sterile treatment room by the sample ophthalmologist
sides, each patient experienced two approaches in order to (JDL) who wore sterile gloves and mask. Sterile swabs were
facilitate the clinical comparison between BCLs and eye used to collect bacterial samples from the lower conjunctival
patching. Patients were not influenced in any way to con- sac (CS) and meibomian gland (MG) secretions on the first
sider one method may be superior to the other to avoid any day before surgery. The bacterial samples from the lower CS,
possibly psychological biasing effects. Patients with contact MG secretions, and corneal incision site were acquired
lens wear within 1-month, recent eye surgery, nasolacrimal immediately at the end of surgery. The lower CS, MG se-
duct obstruction, corneal diseases, eye trauma, eye infection, cretions samples were collected at Day 1 and Day 7.
glaucoma, and ocular fundus diseases were excluded from Moreover, the samples of the corneal incision site and the
the study population. disposed BCLs were obtained at Day 7. The BCLs were
removed at the slit lamp using sterile forceps without topical
2.2. Examinations Procedure. The clinical assessments of the anesthesia. All the samples were placed in the sterile
enrolled participants were conducted in the following order Eppendorf tubes (Axygen, USA) and stored at 4°C.
at the clinical first visit: collection of demographic infor-
mation, best-corrected visual acuity (BCVA), Visual
2.5. Bacterial Culture and Phylogenetic Analysis of 16S rRNA
Function Index (VF-14) questionnaire, [13] visual analog
Sequence. Microbial culture and identification were con-
scales of 10 specific symptoms which were used to assess the
ducted based on previous studies [16]. The samples were
patient’s subjective symptoms (dryness, foreign body sen-
inoculated in blood-agar media within 24 hours of collec-
sation, ache, burning, tearing, asthenopia, blur, itching,
tion. After a 72-hour incubation at 37°C, colonies with
secretions, and photophobia) [14], painful hours, sleep
different phenotypes were selected for further analysis. The
quality [15], and slit-lamp examination (conjunctival in-
16S rRNA gene was amplified by using colony PCR using
jection, subconjunctival hemorrhage, corneal edema, keratic
primers 27F and 1492R [17, 18]. PCR products were se-
precipitate, and anterior chamber flare) which were used as
quenced by Tianyi Huiyuan Biotechnology Company
postoperative inflammation indicators. The Keratograph 5M
(Beijing, China). Correct species identification was obtained
(Oculus Optikgeräte GmbH, Wetzlar, Germany) was used to
by comparing the 16S rRNA gene sequences and the se-
measure the noninvasive tear break-up time (TBUT) and
quence similarities were analyzed using the Basic Local
tear meniscus height (TMH) on the first day before the
Alignment Search Tool (BLAST, https://blast.ncbi.nlm.nih.
surgery and on Day 7. It is important to note that the
gov/Blast.cgi). For phylogenetic analysis, the 16S rRNA
Keratograph was conducted at 30 min following BCL re-
sequences of all strains were aligned using the closely
moval to reduce the influence of ocular procedures at Day 7.
related species as references using CLUSTAL_W. [19] The
Visual analog scales of 10 specific symptoms on the first day
maximum-likelihood [20] was selected to construct the
before the surgery, Day 1, and Day 7 were collected. Sat-
phylogenetic tree using MEGA version 7.0. [21].
isfaction scores (Table 1) were assessed on Day 7. Slit-lamp
microscope examination was carried out at each visit by the
same doctor, and the signs including subconjunctival 2.6. Statistical Analysis. All the analyses were performed
hemorrhage, conjunctival congestion, corneal swelling, using the SPSS version 23.0 software. The Kolmogorov-
keratic precipitates, and anterior chamber flare were eval- Smirnov test was applied to determine the data normality.
uated using a dichotomous scale and recorded as absent or The descriptive data are presented as mean and standard
present. deviations (SD). The independent t test was adopted to
compare the differences between the two groups for con-
2.3. Surgical Technique. All patients were given levofloxacin tinuous variables and the Wilcoxon nonparametric test was
eye drops (Santen, Japan) four times a day from three days applied for ordinal variables. Statistical significance was set
before surgery. Different eyes in the same patient were at p < 0.05.
Journal of Ophthalmology 3

Table 1: Satisfaction questionnaire of postoperative cataract regime.

Item Score (0–10)/choice
Patient satisfaction score of eye patching
Patient satisfaction score of bandage contact lenses
The preference for which regime of second eye
The willing to recommend which regime to your friends

3. Results (G+), C. glutamicum (G+), and E. faecalis (G−). The phylo-

genetic analysis indicated that most isolated strains from the
3.1. Demographics. A total of 16 patients were included in patients’ eyes were within the Gram-positive Staphylococcus
the baseline of the study. The average age of patients was and Bacillus.
74.8 ± 6.7 y (range, 64–86 y; 8 women).
3.6. Safety Evaluation Based on Bacterial Culture and
3.2. Visual Function. There were no differences in the BCVA Identification. The positive rate of bacterial cultures in
and VF-14 between the two groups at baseline or at follow- different swabs is shown in Table 4. Group A did not differ
up visits (p > 0.05). However, the BCVA and VF-14 of all the significantly from Group B in culture positivity. The
patients had improved compared to the levels prior to microbiomes isolated from the samples are shown in Table 5.
surgery. In both the CS and MG secretions, most of the isolated
bacteria were Gram-positive, including Staphylococcus epi-
3.3. Patient Subjective Symptom Evaluation. The differences dermidis and Staphylococcus aureus. Two cases that were
in the patient subjective symptom scores (mean ± SD) be- culture-positive were undetectable by the 16s rRNA Gene
tween the two groups were not significant at baseline. There Sequencing, which were termed “Fail,” and warranted fur-
were no significant differences in patient subjective symp- ther characterization.
tom scores between the two groups on the first postoperative
day. No differences were observed in painful time and sleep 3.7. Patient Satisfaction. The patient satisfaction score of
quality. Moreover, subjective symptom scores showed no Group A was higher than Group B but was not statistically
significant differences at the 1-week follow-up. After cataract different (8.38 ± 1.59 vs. 7.63 ± 1.75, p � 0.213); 75% of the
surgery, patient subjective symptom scores decreased in patients preferred wearing the BCLs, while only 25% of the
both groups at Day 1 and Day 7; however, the differences patients showed equivalent preference for eye patching.
were not significant except for asthenopia and blurred vision Similarly, they were willing to recommend the same ap-
(Table 2). proaches to their friends.

3.4. Patient Objective Signs Evaluation. The differences in 4. Discussion

TBUT (mean ± SD) and TMH between the two groups were
Currently, eye patching in the postoperative period of
not significant at baseline (p � 0.710, p � 0.240). For both
cataract remains routine regimen. Until recently, tight eye
TBUT and TMH, there were no significant differences be-
patching following placement of ointment could increase the
tween Group A and Group B at the 1-week follow-up
risk of toxic anterior segment syndrome [22]. In addition,
(p � 0.706, p � 0.482). Conjunctival injection, subcon-
eye patching following routine cataract surgery is associated
junctival hemorrhage, keratic precipitates, and anterior
with an increase in corneal edema and slower visual recovery
chamber flare showed no statistically significant difference
on the first postoperative day [23]. More ophthalmologists
between the two groups at the 1-day and 1-week visit
have recognized that patching may be not the best choice for
(Table 3). Besides, no serious complications were found in all
patients [2]. It has been shown that no differences in safety in
patients such as acute conjunctivitis, keratitis, endoph-
the postoperative management of cataract are observed
thalmitis, anaphylaxis, and corneal epithelial injury.
regardless of patching; thus, further efforts are to be directed
towards enhancing patient comfort and acceptance [24]. The
3.5. Phylogenetic Analysis of Isolated Bacteria. silicone hydrogel BCL has higher oxygen permeability and
Phylogenetic analysis revealed that all isolated bacteria were water absorbability; thus, it has been used extensively in
divided into genus Staphylococcus, Bacillus, Micrococcus, ocular surface diseases [12, 25]. Motivated patients with
Agromyces, Gordonia, Enterobacter, and Corynebacterium bilateral age-related cataract were recruited who were willing
(Figure 1). Most of bacteria with high similarities belong to to undergo cataract surgery at different days, in order to
the Gram-positive Staphylococcus, including S. epidermidis, ensure accuracy regarding the satisfaction and safety of
S. aureus, S. hominis, and S. lugdunensis. Some bacteria BCLs, which are used after cataract surgery, and pairwise
belong to the Gram-positive Bacillus, including comparison was conducted to reduce bias.
B. amyloliquefaciens, B. proteolyticus, B. tequilensis, and Visual analog scale rather than the ocular surface disease
B. velezensis. A few bacteria were belonging to the index (OSDI) questionnaire was used to measure the syn-
A. mediolanus (G+), M. aloeverae (G+), G. hongkongensis dromes since OSDI cannot distinguish the concerned eye
4 Journal of Ophthalmology

Table 2: Patient subjective symptom scores of patients.

Baseline Day 1 vs baseline Day 7 vs baseline
Group A Group B P Group A Group B P Group A Group B P
Dryness 2.94 ± 2.91 2.75 ± 2.91 NS 1.25 ± 1.95 1.56 ± 2.37 NS 2.00 ± 2.90 0.75 ± 1.73 NS 0.026
Foreign body sensation 2.31 ± 3.40 2.25 ± 3.47 NS 1.38 ± 2.36 2.81 ± 3.60 NS 1.94 ± 2.54 1.00 ± 1.71 NS
Burning 0.25 ± 0.77 0.25 ± 0.77 NS 0 0 NS 0 0 NS
Tearing 1.81 ± 2.64 1.81 ± 2.64 NS 1.63 ± 2.92 1.25 ± 1.98 NS 0.69 ± 1.82 0.69 ± 1.82 NS
0.033
Asthenopia 3.56 ± 2.71 3.56 ± 2.71 NS 1.44 ± 2.66 0.53 ± 1.45 2.06 ± 2.17 2.00 ± 2.07 NS
0.001
Symptom
0.000
Blurred vision 6.56 ± 2.31 5.94 ± 2.41 NS 4.88 ± 3.59 3.39 ± 2.66 NS 0.012 2.69 ± 2.85 2.63 ± 2.78
0.001
Itching 2.38 ± 3.16 2.19 ± 3.21 NS 0.56 ± 1.75 0.67 ± 1.40 NS 1.06 ± 1.95 1.06 ± 1.95 NS
Secretions 2.63 ± 2.75 2.00 ± 2.48 NS 1.38 ± 2.58 0.5 ± 1.10 NS 0.038 1.13 ± 1.41 1.25 ± 1.65 NS
Photophobia 2.38 ± 2.99 2.31 ± 2.98 NS 1.53 ± 2.17 0.53 ± 1.13 NS 0.038 1.19 ± 2.04 1.27 ± 2.09 NS
Ache 2.06 ± 2.99 2.19 ± 3.00 NS 1.00 ± 1.90 1.36 ± 2.58 NS 1.13 ± 1.78 0.88 ± 1.75 NS
NS: no significant differences.

Table 3: Outcomes of postoperative inflammation indicators.

Postoperative Day 1 Postoperative Day 7
Time points
Group A n (%) Group B n (%) P Group A n (%) Group B n (%) P
Subconjunctival hemorrhage 2 (12.5) 4 (25) 0.37 1 (6.25) 1 (6.25) NS
Conjunctival injection 15 (93.75) 16 (100) 0.16 0 (0) 1 (6.25) NS
Corneal edema 11 (68.75) 11 (68.75) 1 0 (0) 0 (0) NS
Keratic precipitate 16 (100) 16 (100) 1 0 (0) 0 (0) NS
Anterior chamber flare 16 (100) 16 (100) 1 8(50) 10 (62.5) NS
NS: no significant differences.

and cannot accurately assess syndromes. There has been valuable methods in the postoperative regime, offering a
much debate about whether wearing BCLs can reduce comparable clinical alternative. The results suggested that no
postsurgery discomfort such as foreign body sensation significant differences of TBUT and TMH were observed
[1, 10, 26]. We noticed that differences between these groups between these groups at Day 1 and Day7, which varied from
regarding postsurgery discomfort did not change signifi- previous reports. Other studies showed that BCLs played a
cantly. Furthermore, the painful time and sleep time showed positive role in stabilizing TBUT and improving TMH
no distinction. All the subjective symptom scores decreased [1, 10, 26]. This could be attributed to the differences of
from baseline, Day 1, Day 7 in both the groups postoper- measurements. Keratograph was used, which permits an
atively; however, only asthenopia and blurred vision showed automated, hypersensitivity, and examiner independent
significant improvement. Discomfort following cataract technique for measuring TBUT. TBUT as measured using
surgery and particularly the eye pain and foreign body the Keratograph was consistently lesser than the subjective
sensation were due to contact between the eyelid and the observer recordings since it can record the first incident of
corneal incision or epithelial damage. Eye patching could break-up anywhere in the tear film [29]. Silicone hydrogel
restrict the motion of eyelid by increasing the willing to close contact lenses are known to aid in stabilizing the tear film,
the eye and therefore enhance epithelial repair and relieve permit corneal healing, and restore normal cell turnover, all
pain or foreign body sensation. BCLs cover the corneal of which are critical to the treatment of ocular surface
surface thus reducing exposure between the eyelid and diseases [30]. Similar findings were reflected in our study.
cornea and protect the cornea from exposure or from the While differences in the TBUT and TMH between eye
irritation caused by rubbing the eye, thereby facilitating patching and BCL were not observed, it is interesting to
corneal epithelium healing [27]. Silicone hydrogel materials speculate that short-term wearing of BCLs may not be
with high oxygen transmissibility, specifically designed for sufficient to produce changes. The ability to stabilize the tear
continuous wear, could secure enhanced wound healing and film could be transient; hence, these changes could not be
epithelial cell reproduction [28]. All the abovementioned captured since the TBUT were measured following 30 min of
factors reduced postoperative pain and foreign body extracting the BCLs. However, others were subjectively
sensation. measured immediately and could not avoid the irritant
Neither group showed any differences in the postop- effects of ocular procedures.
erative inflammation indicators at Day 1 and Day 7, which Extended and overnight soft contact lens wear has been
were consistent with previous studies [1, 10]. No cases of identified as a risk factor for corneal infection. [31]
severe corneal injury or postoperative inflammation were Endophthalmitis is the most severe complication following
identified. Hence, BCL and patching both may be considered cataract surgery. Assessing the presence of bacteria is crucial
Journal of Ophthalmology 5

3–4–1
27–6–1
2–10–2
4–1–1
4–1
19–2–2
23–7–1

Staphylococcus epidermidis NCTC 8325

4–8–1
4–8
13–6
19–1–1

30–1–2
Staphylococcus aureus ATCC 12600
27–7–1
30–1–4
30–1–1
30–1–3
30–2–1
30–3–1
30–2–2
31–4–1
31–4–2
8–10
Bacillus subtilis 168
Micrococcus aloeverae AE-6

Bacillus proteolyticus MCCC1A00365

2–10–1
Enterococcus faecalis ATCC19433
2–6–1
Agromyces mediolanus JCM 3346
22–7–1

Gordonia terrae DSM43249

17–3
0.05 Corynebacterium glutamicum ATCC13032
29–5–1

Figure 1: Phylogenetic tree based on 16S rRNA gene sequences. Maximum-likelihood phylogenetic tree is constructed based on the
bacterial 16S rRNA gene sequences. Numbers at the nodes are ML bootstrap proportions. Bar represents 0.05 substitutions per nucleotide
position.

for using BCLs in postoperative cataract surgery. A previous week period) using BCLs were obtained. The bacterial
study has evaluated the safety of overnight BCLs through culture positivity showed no statistically significant differ-
bacterial culture and biochemical identification, [10] al- ences between these two groups. The organisms most fre-
though conclusions were limited by short-term wearing, quently cultured were Staphylococcus epidermidis and
which could not indicate the safety and efficacy for long- Staphylococcus aureus. The present study indicates that
term use. Bacterial incubates were obtained from different selecting BCLs following cataract surgery is safer compared
parts at selected time points and continuous samples (one- to eye patching. Consistent with previous studies [32],
6 Journal of Ophthalmology

Table 4: The incidence of positive bacterial cultures and species distribution.

Sample’ sources Group A positive culture rate (patient) Group B positive culture rate (patient) P
Pre-op CS 6.25% (4) 12.5% (19,30) NS
Pre-op MG 6.25% (4) 12.5% (19,30) NS
Post-op Day 0 CS 0 12.5% (17,30) NS
Post-op Day 0 MG 12.5% (3,31) 0 NS
Post-op Day 0 corneal incision 0 6.25% (29) NS
Post-op Day 1 CS 6.25% (13) 12.5% (2,27) NS
Post-op Day 1 MG 0 18.75% (22,23,27) NS
Post-op Day 7 CS 6.25% (4) 0 NS
Post-op Day 7 MG 0 0 NS
Post-op Day 7 corneal incision 0 12.5% (2,8) NS
Post-op Day 7 BCL 0 — —
CS: conjunctival sac. MG: meibomian gland. BCL: bandage contact lens. Pre-op: before surgery. Post-op: after surgery. NS: no significant differences.

preoperative prophylactic antibiotics are an effective treat- Gram-positive cocci usually found in the normal human
ment despite revealing the presence of bacteria in a small gastrointestinal tract and is an uncommon cause of
number of samples. It was of interest to note that some eyes endophthalmitis. [38] However, it accounted for 2.2% of the
with preoperative negative cultures were immediately pos- culture-proven acute-on-set postoperative endophthalmitis
itive following surgery no matter in CS, MG, or corneal following cataract surgery or secondary intraocular lens
major incision. This could be since MG secretions continue implantation in the endophthalmitis in the endophthalmitis
during the operations, especially after lid speculum place- vitrectomy study [39]. Despite adequate interventions, the
ment [33]. Moreover, Group B showed more positive results outcome of Enterococcus endophthalmitis was poor vision
in the cultures of postoperative Day 1. Povidone-iodine is [40]. Treatment is complicated since it is highly resistant
reportedly effective in reducing conjunctival bacterial flora [41]. BCLs used in postoperative cataract did not show
[34]. It has been shown that a small amount of PI remains in bacterial growth and there was no evidence of infection,
the conjunctival sac at the time of operation, which could which might be attributed to the antibiotic prophylaxis, high
prevent bacterial contamination [33]. A recent study re- oxygen permeability of the BCLs, and autoimmunity to
ported that the 0.66% PI eye drops used for three days prior bacteria.
to cataract surgery were effective in reducing the conjunc- For the BCVA and VF-14 score, the difference was not
tival bacterial load [35]. Moreover, Oliverio et al. [36] hy- statistically significant between the groups. Therefore, BCLs
pothesized that PI acting on ocular surface microbiota may may not disrupt visual function. Regarding the satisfaction
rebalance the anomalous bacterial overgrowth typical of with the two regimes, subjective feeling was used to reflect
DED, resulting in a reduction of the inflammatory stimulus the patients’ satisfaction in previous studies. A more precise
on the ocular surface epithelial cells, thus relieving symp- and quantitative means of satisfaction should be designed to
toms of dry eye. indicate patient satisfaction. BCL group had a higher patient
The polymer structure of the soft BCLs could act as a satisfaction score than the eye patching group, although the
reservoir, which could prolong the duration of antibiotic differences did not achieve statistical significance. Most
eyedrops or PI. Although PI was considered to possess patients (85%) showed more preference for BCLs, and the
corneal toxicity, which depends on the concentration, di- major reason was instant vision, which is advantageous for
luted PI had a higher bactericidal efficiency owing to greater normal life and reducing accident. Clearly, instant vision
availability of diatomic free iodine in dilute solution, the provides better orientation and improved vision immedi-
bactericidal component of PI [34]. And PI seems to contain ately following surgery, which was obtained from the BCLs.
factors that may favor the ocular surface protection such as These findings led to more patients opting for ambulatory
glycerol and vitamin E d-alpha-Tocopherol Polyethylene surgery with BCLs that reduced hospitalized anxiety.
Glycol (vit ETPGS) [36]. Corneal toxicity and DED pro- Twenty-five percent of the patients chose eye patching since
tection in low-concentration PI retention of BCLs warrant they believed patching may provide more protection and
further study. more rest for the eyes. All these data supported the hy-
Recent researches [3, 37] have shown that the silicon pothesis that BCLs could be a good alternative to eye
material also exhibits a good capacity for water absorption patching. The main contributions of this paper are sum-
and BCLs application to the eye, causing the stagnation of marized as follows: We recruited motivated patients with
the liquid beneath the BCLs. Therefore, the silicon could bilateral age-related cataract that can more accurately reflect
help lock in water mimicking the lipid layer, thereby re- the truth about the satisfaction and safety of BCLs. We
ducing tear evaporation, and locking drugs possible. Hence, developed bacterial cultures obtained from different sites
patients should receive antibiotics in the immediate post- and at various time points perioperatively that can reveal the
surgical period. BCLs provide a convenient method for this alteration in the ocular flora.
intervention. It is particularly interesting that Enterococcus The present study has several limitations. First, the
faecalis was seen in patient 2 of Group B. Enterococcus is sample size was small; further studies with larger number of
 Table 5: Bacteria isolated in samples among Group A and Group B.
Isolated Post- Post-
Journal of Ophthalmology

bacteria in Post-op Day 0 Post-op Day 0 Post-op Day 1 Post-op Day 1 Post-op Day 7 op Post-op Day 7 op
Pre-op CS Pre-op MG Post-op Day 0 MG
Groups A CS corneal incision CS MG CS Day 7 corneal incision Day 7
and B MG BCL
Patient
— — — S. epidermidis — — — — — — —
3
Patient
S. epidermidis Unknown — — — — — S. epidermidis — — —
4
A
Patient
— — — — — S. epidermidis — — — — —
13
Patient B. amyloliquefaciens
— — — — — — — — — —
31 B. velezensis
Patient B. proteolyticus
— — — — — E. faecalis — — — —
2 S. epidermidis
Patient
— — — — — — — — — B. tequiensis —
8
Patient Gordonia
— — — — — — — — — —
17 hongkongensis
Patient
S. epidermidis S. epidermidis — — — — — — — — —
19
Patient Agromyces
B — — — — — — — — — —
22 mediolanus
Patient
— — — — — — S. epidermidis — — — —
23
Patient
— — — — — S. epidermidis S. aureus — — — —
27
Patient Corynebacterium
— — — — — — — — — —
29 glutamicum
Patient S. aureus
S. aureus S. aureus — — — — — — — —
30 S. haemolyticus
CS: conjunctival sac. MG: meibomian gland. BCL: bandage contact lens. Pre-op: before surgery. Post-op: after surgery.
7
8 Journal of Ophthalmology

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