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    Strategies for starting a CXL practice


    Preop, intraop strategies

    Preoperatively, all eyes receive a typical povidone-iodine scrub with a drop of 5% topical povidone-iodine for infection prophylaxis. To improve comfort, patients are given 0.5 mg lorazepam sublingual 30 minutes before the procedure.

    Intraoperative strategies for complication prevention include use of 0.02% mitomycin-C for 30 to 60 seconds to prevent haze in eyes having a combined phototherapeutic keratectomy (PTK) or TCAT PRK.  Ensuring that pachymetry readings remain ≥400 μm reading throughout the procedure is helpful for controlling pain and minimizing more serious risks of uveitis and endothelial decompensation. Hypotonic riboflavin or BSS are used if needed.

    Avoiding treatment of the limbus is important for preventing delayed healing, and devices can be purchased to protect this area of the eye

    At Dr. Chan’s center, all patients maintain bandage contact lens wear and remain on a topical fluoroquinolone until the epithelium is fully healed. To promote epithelial healing, they are instructed to use preservative free tears as frequently as possible (every hour), and then to continue with the ocular lubricant four times daily after re-epithelialization has occurred.

    Topical corticosteroid treatment is used to prevent haze, and Dr. Chan’s regimen begins with dexamethasone until bandage contact lens removal. Then patients are switched to a tapering fluorometholone regimen.

    “Darker pigmented patients, however, who are at increased risk for severe haze, are kept on dexamethasone for a more aggressive taper,” she said.

    Treatment for pain control treatment includes a topical NSAID for 2 days and oral Percocet for 2 days.
    “We found Tylenol #3 does not work well enough,” Dr. Chan said.

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