Performance of Bandage Contact Lens in Patients Post-ocular Surgeries: A Systematic Literature Review
This systematic review process followed Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. The protocol was registered in PROSPERO (CRD42022366437). The English and Chinese databases were searched for articles reporting the performance of BCLs after different ocular surgeries published from the inception of respective databases to December 2021. The selection and data extraction were performed by two independent reviewers based on the study outcomes. The methodological quality of eligible randomized control trials (RCTs) and observational studies was determined using the JADAD scale and the Newcastle–Ottawa scale, respectively. The search terms for each category, database, inclusion/exclusion criteria, and full methodological information are provided in the Supplementary (see Appendix, Supplemental Digital Content, http://links.lww.com/ICL/A272 ).   Of 12,836 articles, 38 articles met the inclusion criteria (Fig. ). The majority of the studies were on corneal refractive surgery (n=26), five on cataract surgery, two on CXL surgery, and five on vitrectomy. The major characteristics of eligible studies are presented in Table . The studies that met the inclusion criteria were published from 2008 to 2021 and included a total of 14,759 patients aged 18 years and older. The types of ocular surgeries that used BCL as postoperative treatment were corneal refractive surgery, cataract surgery, CXL surgery, and vitrectomy. The majority of the studies were from Iran (n=6), China (n=4), Turkey (n=4), the United States (n=3), and other countries accounting for the remainder. All studies on cataract and vitrectomy surgeries were from China, whereas those on CXL surgery were from Turkey. The follow-up time varied from 3 days to 6 months. The results of the quality assessment included 68.4% of mostly moderate articles (Table ). Effect of Bandage Contact Lens Usage After Corneal Refractive Surgeries Among the articles finalized, the aforementioned BCL usage was most commonly found after PRK surgery (n=18), followed by LASIK (n=5) surgeries, whereas the number of studies related to LASEK (n=2) and SMILE (n=1) surgeries was less. Among the BCL materials, a greater number of articles were related to lotrafilcon B (n=8), followed by balafilcon A (n=6), senofilcon A (n=4), lotrafilcon A (n=4), and comfilcon A (n=4). Photorefractive Keratectomy In total, 11 RCTs and seven observational studies related to PRK surgeries were included in the study. , , , – The follow-up duration varied from 3 days to 6 months. The BCL wear time after surgery varied from 3 days to 1 week. Thirteen studies reported postoperative pain scores on day 1, 8 studies in 2 to 3 days, and five studies in 4 to 7 days. The patient profile and outcomes after PRK surgeries are summarized in Table S1, Supplemental Digital Content, http://links.lww.com/ICL/A272 . Exchanging BCL every day after PRK lowered postoperative pain on day 1 ( P =0.009) compared with the eye treated with the same BCL without exchange, whereas the response was similar thereafter. The removal of BCL on the fourth or seventh postoperative day did not affect the pain response on day 1 ( P =0.20). The removal of BCL on the seventh postoperative day had lower pain scores compared with the removal on the fourth postoperative day ( P =0.07). Considerable reduction in pain was observed on the third postoperative day compared with the first postoperative day, with the pain tapering off from the fourth day with lotrafilcon B, comfilcon A, lotrafilcon A, balafilcon A, and senofilcon A eyes. , , , – Lesser pain was observed with senofilcon A on the first postoperative day compared with other BCLs. , , No significant difference in pain response in patients wearing similar BCL materials, lotrafilcon A and lotrafilcon B, as well as PureVision and PureVision2 ( P >0.05) was observed. Similar trend of improvement in BCL epiphora scores was observed with lotrafilcon B, senofilcon A, and balafilcon A, , , and comfort scores with comfilcon A and lotrafilcon B were similar. Photophobia scores decreased from the first to the third postoperative day with BCLs. Foreign body sensation was less with lotrafilcon B on the first and third postoperative day compared with that with other BCLs. Nine studies discussed the effect of BCL on epithelial defect. Epithelial defect reduced considerably on the third postoperative day compared with that on the first postoperative day with BCL application. Eight studies observed that epithelial defect with lotrafilcon B, lotrafilcon A, and senofilcon A reduced considerably from the first to third postoperative day. , , , – The re-epithelialization time for most BCLs was 3 to 4 days, , , , and the percentage of eyes that went through complete re-epithelialization ranged from 70% to 83% on postoperative day 3. , , The epithelial defect was similar between PureVision1 and PureVision2 lenses. Furthermore, LogMAR visual acuity scores for the lotrafilcon A and senofilcon A groups improved from the first postoperative day (0.19±0.20 and 0.23±0.22, respectively) to the fifth postoperative day (0.14±0.12 and 0.17±0.15, respectively). Uncorrected visual acuity (UCVA) was improved considerably on the seventh postoperative day with BCL application. The removal of BCL on the seventh postoperative day was beneficial compared with that on the fourth postoperative day in visual rehabilitation (corrected distance visual acuity and uncorrected distance visual acuity; P =0.016) after 1 month. A similar study showed that the removal of BCL on the third or fifth postoperative day yielded no significant benefits in visual acuity. The only study on infection observed less tear secretion in the patient eye using BCL after PRK was prone to bacterial contamination. Laser Epithelial Keratomileusis Surgery Two studies with an application of BCL after LASEK were included. Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics of BCL usage after LASEK surgeries. Xie et al. demonstrated milder postoperative symptoms with the usage of balafilcon A (P<0.05), shorter healing time (4.07±0.25 days vs 4.33±0.82 days in hydrogel group), and better improvement in visual acuity, whereas BCL reduced subjective pain and tear symptoms. Laser-Assisted In Situ Keratomileusis Surgery Two RCTs and observational studies were included for LASIK surgery (see Table S3, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). Postoperative pain and photophobia were milder in eyes with BCL compared with those without BCL ( P =0.04 and P =0.003, respectively), with fibrotic healing being markedly significant in the eyes with BCL compared with control eyes ( P <0.001) at 6 months. The visual acuity was worse in the eyes with BCL (removed 1 day after surgery) compared with control eyes on the first postoperative day but was similar after 6 months. BCL after LASIK surgery showed improvement in pain scores ( P <0.05) and epithelial recovery ( P <0.05), better epithelial improvement ( P <0.05), lesser discomfort ( P <0.05), and faster corneal healing with a wear time of 7 days compared with no BCL. Small Incision Lenticule Extraction Surgery Table S4, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics and outcomes of BCL usage after SMILE surgery. An RCT on BCL application after SMILE observed the highest symptom score after 2 hr of surgery, which declined at 4, 8, and 24 hr in three patient groups. At 2 hr after surgery, statistically significant lower symptom scores were reported with groups A and B ( P =0.012 and P =0.020, respectively) compared with group C, whereas no difference between groups A and B was observed ( P =0.814). Scores reduced faster in group C compared with groups A and B from 2 to 4 hr after surgery, whereas no difference between groups was observed at other time points. The effect of BCL on other outcomes such as blurred vision, photophobia, tearing, corneal edema, and UCVA was reported. Effects of Bandage Contact Lens Usage After Cataract Surgery Two RCTs and four observational studies were included in the study. The outcomes of BCL usage after cataract surgery are summarized in Table S5, Supplemental Digital Content, http://links.lww.com/ICL/A272 . All six studies compared eyes with BCL with either eye treated with usual care, which consisted of local antibiotic therapy combined with an eye pad or only antibiotic therapy. The wear time of BCLs by patients from three studies , , was 7 days after surgery. A study by Chen et al. showed statistically significant improvements in Ocular Surface Disease Index scores at 1 week ( P <0.001) and 14 days after surgery ( P <0.001) in the BCL eye compared with the untreated eye. Similarly, subjective evaluation scores, tear film break-up time, and fluorescein staining improved at week 1 ( P =0.031, P =0.021, and P =0.03, respectively) and day 14 ( P =0.009, P =0.021, and P =0.032, respectively) in the BCL eye compared with the untreated eye. Lipid tear dysfunction (NIf-BUT; P =0.008), bulbar redness ( P =0.047), and Schirmer I test score ( P =0.013) showed significant improvement with BCL at 1 month after surgery with reduced inflammation, whereas the tear break-up time ( P <0.001) and corneal fluorescein score ( P =0.004) improved rapidly in eyes with BCL compared with those with eye pads 3 months after surgery. Patient satisfaction scores were higher in the BCL group compared with the eyepatch group (8.38±1.59 vs 7.63±1.75; P =0.213), whereas lower corneal fluorescein staining scores ( P <0.05) were observed 3 days after surgery with BCL. The pain scores improved within 8 hr ( P <0.05) and 3 days ( P <0.05) in the BCL group compared with the control group. Effects of Bandage Contact Lens Usage After Corneal Cross-Linking Surgery Table S6, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the main outcomes of BCL usage after CXL surgery. One RCT and one observational study were included in the study. Balafilcon A and hioxifilcon A lenses reduced pain, eyelid edema, conjunctival hyperemia, irritation, and burning on the third postoperative day compared with the first postoperative day. Complete corneal re-epithelialization was observed after 3 days in both groups after which lenses were removed from the patient's eyes. Similar results were observed with lotrafilcon B (24, 60). Decreased pain scores from the first (4.61±2.3 and 4.06±2.2, respectively) to the third postoperative day (0.91±1.43 and 4.06±2.2, respectively) were observed in the balafilcon and lotrafilcon B groups. The BCL usage reduced epithelial defect size considerably from the first to the third postoperative day. Epithelial defect size was smaller in the lotrafilcon B group compared with the balafilcon A group on day 1 ( P <0.001) and day 2 ( P =0.039). Effects of Bandage Contact Lens Usage After Vitrectomy Surgery Three RCTs and two observational studies were included in the study (see Table S7, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). Balafilcon A (n=4), senofilcon A (n=1), and lotrafilcon A (n=1) were used for postvitrectomy treatment with a wear time varying from 1 to 7 days. Corneal fluorescein staining score was 0.61±0.62 with senofilcon A lens and 1.81±1.26 in eyes without BCL on the first postoperative day ( P =0.003), whereas no difference in corneal fluorescein sodium staining positive rate was observed between the lotrafilcon A and balafilcon A groups ( P =0.848) at seventh postoperative day. Ocular irritation ( P <0.05) and ocular pain ( P <0.05) improved significantly in the patient eyes with balafilcon A compared with the no BCL group on the seventh postoperative day. The BCL usage improved epithelial defect ( P =0.0002) on 14th postoperative day and improved tearing ( P =0.005) and reduced pain on seventh postoperative day compared with the no BCL group. A retrospective study observed that BCL could effectively treat corneal epithelium defects after vitrectomy. Maximum benefit was observed on the 14th postoperative day. This systematic review summarizes studies reporting the immediate use of BCLs in postoperative care for ocular surgeries using published evidence. We have reviewed the performance of five BCL materials applied after different types of ocular surgeries to understand the beneficial patient profiles and optimal wear time associated with maximal benefits specific to each surgery (Table ). The use of BCLs has been recognized to offer benefits after ocular surgery (Table ). Benefits of Using Bandage Contact Lenses After Corneal Refractive Surgeries Photorefractive Keratectomy PRK is a refractive surgical ablation performed on the corneal surface after epithelial debridement. Bandage contact lenses are known to relieve postoperative PRK side effects and facilitate faster re-epithelization of the cornea with improved wound healing, thus accelerating visual rehabilitation. The pain intensity is known to peak at 24 to 72 hr after the PRK procedure, which then decreases through day 5. – Another study on postoperative care in corneal refractive surgery showed that pain peaked during the first 24 hr with a median duration of 3 days. Approximately 52% of patients recorded a higher pain score of greater than 7 during these 3 days. This review showed that the application of BCLs reduced early postoperative pain (day 1), whereas a notable reduction in pain response was observed on the third postoperative day with negligent pain response observed on the fourth day after PRK (see Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). The removal of BCLs either on the third day after surgery or later did not affect the duration of the reduction in pain response. , Other studies observed that exchanging BCL every day after surgery minimized early postoperative pain. In most of the studies after PRK, the postoperative medication regimen included the use of topical antibiotics, steroids, and/or nonsteroidal anti-inflammatory drugs (NSAIDs) (see Table S9, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). In two studies, NSAID was applied during the procedure before BCL. , Postoperative moxifloxacin – , , was widely used among other antibiotics. The studies reported uniform administration of postoperative medication regimens such as antibiotics, steroids (betamethasone, loteprednol, prednisolone, and fluorometholone), NSAIDs (diclofenac, nepafenac, and ketorolac), and opioids (in few studies) were applied to both eyes including control or between comparisons of BCLs eyes after PRK. – Among other outcomes, epiphora scores and comfort scores improved by day 3 after surgery on BCL application, whereas photophobia scores and foreign body sensation decreased by the third day after surgery. , , , , Pain is known to subside when re-epithelialization of the cornea is completed. , After PRK, the corneal surface is known to regenerate in 3 to 4 days. Bandage contact lenses reduce epithelial defect size considerably on the third postoperative day compared with the first postoperative day with maximum benefits observed with lotrafilcon B (41) among the selected BCLs for the study. Complete re-epithelialization was observed in 72.7% to 83% of patients within 3.1–3.6 days with different BCLs. Bandage contact lenses are often removed after the completion of re-epithelialization of the cornea after PRK. Proper re-epithelialization facilitates improved visual acuity after 1 month of surgery. , Removal of BCL 7 days after surgery improves visual acuity at 1 month compared with the removal of BCL on the fourth day after surgery. Table S8, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the benefits associated with types of BCLs with limited studies focusing on long-term benefits. , , , – Future clinical trials are warranted to understand the effect of BCLs on all visual outcomes associated with PRK. Findings from most studies related to PRK, irrespective of BCL material used, suggest that wear time of 3–4 days after surgery will yield maximum benefits in managing postoperative symptoms and facilitation of early rehabilitation. The risk of infections is also low with BCL usage. Although the study by Mohammadpour et al. suggested that wearing BCLs for 7 days after surgery will reap maximum visual benefits, more studies need to be conducted to validate the results. Other Postcorneal Refractive Surgeries Laser Epithelial Keratomileusis Surgery After LASEK surgery, BCL application is known to protect the corneal wound and relieves patient discomfort. LASEK surgeries are known to cause pain in the first few hours with minimal or no pain at 24 hr. The beneficial effect of shorter corneal epithelial healing time (4.07 days), lesser discomfort, and more improvement in unaided eye vision was observed with 4 to 6 days of BCL wearing time. Late-onset shedding of corneal epithelium was not observed with BCL. In addition, BCL application reduced postoperative symptoms such as pain, photophobia, foreign body sensation, and tear score in patients who underwent LASEK surgery. Decreased pain, tearing, and sensation of dryness were observed on day 3 after surgery; negligible pain response, tearing, and sensation of dryness were observed on day 7 after surgery. These outcomes depict the beneficial effect of BCL usage after LASEK within a wear time of 5 days. The beneficial time was similar for the two BCL materials used in these studies. Laser-Assisted In Situ Keratomileusis Surgery After LASIK surgeries, along with the other beneficial effects that BCL has after refractive surgeries, BCL is also known to reduce the intense fibrotic wound healing response at the flap margins after LASIK. LASIK surgeries are also known to cause pain in the first few hours with minimal or no pain at 24 hr. BCL wear time of 1 day after surgery improved pain, photophobia, tear reduction, and fibrotic healing of FLAP ; 3-day wear time improved dry eye parameters and tear-film breakup time 1 month after the surgery, whereas fast corneal healing with good visual acuity outcomes was observed with 7 days of BCL wear time after LASIK. Furthermore, day and night wearable corneal contact lenses (silicone hydrogel) with higher DK/L (110×10 −9 barrer/mm) permit high oxygen transmissibility and showed significant improvement in epithelial healing for 4 to 7 days. Milder postoperative symptoms with greater improvement in pain response and corneal epithelial healing were observed during the 7-day postoperative BCL wear. , These findings indicate that 7-day post-LASIK BCL wearing time would reap maximum benefits. Small Incision Lenticule Extraction Surgery The only study on post-SMILE surgery treatment demonstrated the beneficial effects of wearing senofilcon A with reduced symptoms of tearing and pain 2 hr after the surgery as well as a reduction in corneal edema at 24 hr after the surgery with a BCL wear time of 8 and 24 hr after surgery compared with no BCL. A beneficial BCL wear time of 8 hr after surgery can be recommended, although more studies are required to validate the same. Benefits of Bandage Contact Lenses After Cataract Surgeries After cataract surgeries, BCLs are known to act as a sealant and improve dry eye syndrome in addition to managing postoperative symptoms. The beneficial BCL wear time of 7 days was observed in most studies except for the study by Xin et al., in which the wear time was 3 days irrespective of the BCL material used. Higher patient satisfaction scores were observed by Jing et al. Improved tear film stability and less dry eye discomfort were observed at 7 days after surgery. The dry eye–related parameters such as stabilization of ocular surface, tear film, inflammation, and corneal healing improved significantly after 1 month. Comfort and tear film stability improved by 7 days and remained the same till 3 months. Early BCL benefits were observed with pain symptoms being reduced as early as 8 hr after surgery and maintained till 3 days, whereas faster corneal epithelial healing was observed at 3 days after surgery. These findings emphasize the benefits of BCL as early as 8 hr until 3 months, alleviating postoperative symptoms and aiding visual rehabilitation with an optimal wear time of 7 days. Benefits of Bandage Contact Lens After Corneal Cross-Linking Surgeries Studies on post-CXL surgery treatment were conducted in Turkey with a BCL wear time of 3 days in patients with keratoconus. Corneal re-epithelialization was completed in 3 days, , and a decrease in pain was observed from the first to third postoperative day. The complete re-epithelialization time ranged from 3.33 to 3.41 days for BCLs. Benefits of Bandage Contact Lens After Vitrectomy Surgeries All studies were from China involving patients with diabetic retinopathy. Improved ocular irritation, lacrimation, and reduced corneal epithelial loss were observed at 7 days of BCL usage. Corneal moist improved with a BCL wear time of 1 day after surgery, whereas corneal integrity after surgery was maintained with a wear time of 7 days. Epithelial defect size was lesser with BCL at 14 days after surgery. BCL is beneficial in comfort, corneal epithelium healing, and visual acuity after vitrectomy surgery with maximum benefit observed at 7 days, whereas visual acuity benefit was observed at 3 months after surgery with 7 days of wear time. To summarize, BCL can be used as effective bandages after corneal refractive, cataract, and vitrectomy surgeries, providing pain relief, reducing postoperative symptoms, and promoting re-epithelialization of the cornea with healing in the early postoperative phase. In addition, BCL improved dry eye symptoms and ocular surface in postcataract surgery. Depending on the type of surgery, patients are recommended to wear BCL immediately after surgery for 8 hr or to 7 days to maximize the beneficial effects. The beneficial wear time for maximum clinical benefits was similar for most BCL materials as observed in most posteye surgeries. Recommendations for timely BCL application immediately after different eye surgeries and its clinical benefits are summarized in Table .   Among the articles finalized, the aforementioned BCL usage was most commonly found after PRK surgery (n=18), followed by LASIK (n=5) surgeries, whereas the number of studies related to LASEK (n=2) and SMILE (n=1) surgeries was less. Among the BCL materials, a greater number of articles were related to lotrafilcon B (n=8), followed by balafilcon A (n=6), senofilcon A (n=4), lotrafilcon A (n=4), and comfilcon A (n=4). Photorefractive Keratectomy In total, 11 RCTs and seven observational studies related to PRK surgeries were included in the study. , , , – The follow-up duration varied from 3 days to 6 months. The BCL wear time after surgery varied from 3 days to 1 week. Thirteen studies reported postoperative pain scores on day 1, 8 studies in 2 to 3 days, and five studies in 4 to 7 days. The patient profile and outcomes after PRK surgeries are summarized in Table S1, Supplemental Digital Content, http://links.lww.com/ICL/A272 . Exchanging BCL every day after PRK lowered postoperative pain on day 1 ( P =0.009) compared with the eye treated with the same BCL without exchange, whereas the response was similar thereafter. The removal of BCL on the fourth or seventh postoperative day did not affect the pain response on day 1 ( P =0.20). The removal of BCL on the seventh postoperative day had lower pain scores compared with the removal on the fourth postoperative day ( P =0.07). Considerable reduction in pain was observed on the third postoperative day compared with the first postoperative day, with the pain tapering off from the fourth day with lotrafilcon B, comfilcon A, lotrafilcon A, balafilcon A, and senofilcon A eyes. , , , – Lesser pain was observed with senofilcon A on the first postoperative day compared with other BCLs. , , No significant difference in pain response in patients wearing similar BCL materials, lotrafilcon A and lotrafilcon B, as well as PureVision and PureVision2 ( P >0.05) was observed. Similar trend of improvement in BCL epiphora scores was observed with lotrafilcon B, senofilcon A, and balafilcon A, , , and comfort scores with comfilcon A and lotrafilcon B were similar. Photophobia scores decreased from the first to the third postoperative day with BCLs. Foreign body sensation was less with lotrafilcon B on the first and third postoperative day compared with that with other BCLs. Nine studies discussed the effect of BCL on epithelial defect. Epithelial defect reduced considerably on the third postoperative day compared with that on the first postoperative day with BCL application. Eight studies observed that epithelial defect with lotrafilcon B, lotrafilcon A, and senofilcon A reduced considerably from the first to third postoperative day. , , , – The re-epithelialization time for most BCLs was 3 to 4 days, , , , and the percentage of eyes that went through complete re-epithelialization ranged from 70% to 83% on postoperative day 3. , , The epithelial defect was similar between PureVision1 and PureVision2 lenses. Furthermore, LogMAR visual acuity scores for the lotrafilcon A and senofilcon A groups improved from the first postoperative day (0.19±0.20 and 0.23±0.22, respectively) to the fifth postoperative day (0.14±0.12 and 0.17±0.15, respectively). Uncorrected visual acuity (UCVA) was improved considerably on the seventh postoperative day with BCL application. The removal of BCL on the seventh postoperative day was beneficial compared with that on the fourth postoperative day in visual rehabilitation (corrected distance visual acuity and uncorrected distance visual acuity; P =0.016) after 1 month. A similar study showed that the removal of BCL on the third or fifth postoperative day yielded no significant benefits in visual acuity. The only study on infection observed less tear secretion in the patient eye using BCL after PRK was prone to bacterial contamination. Laser Epithelial Keratomileusis Surgery Two studies with an application of BCL after LASEK were included. Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics of BCL usage after LASEK surgeries. Xie et al. demonstrated milder postoperative symptoms with the usage of balafilcon A (P<0.05), shorter healing time (4.07±0.25 days vs 4.33±0.82 days in hydrogel group), and better improvement in visual acuity, whereas BCL reduced subjective pain and tear symptoms. Laser-Assisted In Situ Keratomileusis Surgery Two RCTs and observational studies were included for LASIK surgery (see Table S3, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). Postoperative pain and photophobia were milder in eyes with BCL compared with those without BCL ( P =0.04 and P =0.003, respectively), with fibrotic healing being markedly significant in the eyes with BCL compared with control eyes ( P <0.001) at 6 months. The visual acuity was worse in the eyes with BCL (removed 1 day after surgery) compared with control eyes on the first postoperative day but was similar after 6 months. BCL after LASIK surgery showed improvement in pain scores ( P <0.05) and epithelial recovery ( P <0.05), better epithelial improvement ( P <0.05), lesser discomfort ( P <0.05), and faster corneal healing with a wear time of 7 days compared with no BCL. Small Incision Lenticule Extraction Surgery Table S4, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics and outcomes of BCL usage after SMILE surgery. An RCT on BCL application after SMILE observed the highest symptom score after 2 hr of surgery, which declined at 4, 8, and 24 hr in three patient groups. At 2 hr after surgery, statistically significant lower symptom scores were reported with groups A and B ( P =0.012 and P =0.020, respectively) compared with group C, whereas no difference between groups A and B was observed ( P =0.814). Scores reduced faster in group C compared with groups A and B from 2 to 4 hr after surgery, whereas no difference between groups was observed at other time points. The effect of BCL on other outcomes such as blurred vision, photophobia, tearing, corneal edema, and UCVA was reported.   In total, 11 RCTs and seven observational studies related to PRK surgeries were included in the study. , , , – The follow-up duration varied from 3 days to 6 months. The BCL wear time after surgery varied from 3 days to 1 week. Thirteen studies reported postoperative pain scores on day 1, 8 studies in 2 to 3 days, and five studies in 4 to 7 days. The patient profile and outcomes after PRK surgeries are summarized in Table S1, Supplemental Digital Content, http://links.lww.com/ICL/A272 . Exchanging BCL every day after PRK lowered postoperative pain on day 1 ( P =0.009) compared with the eye treated with the same BCL without exchange, whereas the response was similar thereafter. The removal of BCL on the fourth or seventh postoperative day did not affect the pain response on day 1 ( P =0.20). The removal of BCL on the seventh postoperative day had lower pain scores compared with the removal on the fourth postoperative day ( P =0.07). Considerable reduction in pain was observed on the third postoperative day compared with the first postoperative day, with the pain tapering off from the fourth day with lotrafilcon B, comfilcon A, lotrafilcon A, balafilcon A, and senofilcon A eyes. , , , – Lesser pain was observed with senofilcon A on the first postoperative day compared with other BCLs. , , No significant difference in pain response in patients wearing similar BCL materials, lotrafilcon A and lotrafilcon B, as well as PureVision and PureVision2 ( P >0.05) was observed. Similar trend of improvement in BCL epiphora scores was observed with lotrafilcon B, senofilcon A, and balafilcon A, , , and comfort scores with comfilcon A and lotrafilcon B were similar. Photophobia scores decreased from the first to the third postoperative day with BCLs. Foreign body sensation was less with lotrafilcon B on the first and third postoperative day compared with that with other BCLs. Nine studies discussed the effect of BCL on epithelial defect. Epithelial defect reduced considerably on the third postoperative day compared with that on the first postoperative day with BCL application. Eight studies observed that epithelial defect with lotrafilcon B, lotrafilcon A, and senofilcon A reduced considerably from the first to third postoperative day. , , , – The re-epithelialization time for most BCLs was 3 to 4 days, , , , and the percentage of eyes that went through complete re-epithelialization ranged from 70% to 83% on postoperative day 3. , , The epithelial defect was similar between PureVision1 and PureVision2 lenses. Furthermore, LogMAR visual acuity scores for the lotrafilcon A and senofilcon A groups improved from the first postoperative day (0.19±0.20 and 0.23±0.22, respectively) to the fifth postoperative day (0.14±0.12 and 0.17±0.15, respectively). Uncorrected visual acuity (UCVA) was improved considerably on the seventh postoperative day with BCL application. The removal of BCL on the seventh postoperative day was beneficial compared with that on the fourth postoperative day in visual rehabilitation (corrected distance visual acuity and uncorrected distance visual acuity; P =0.016) after 1 month. A similar study showed that the removal of BCL on the third or fifth postoperative day yielded no significant benefits in visual acuity. The only study on infection observed less tear secretion in the patient eye using BCL after PRK was prone to bacterial contamination.   Two studies with an application of BCL after LASEK were included. Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics of BCL usage after LASEK surgeries. Xie et al. demonstrated milder postoperative symptoms with the usage of balafilcon A (P<0.05), shorter healing time (4.07±0.25 days vs 4.33±0.82 days in hydrogel group), and better improvement in visual acuity, whereas BCL reduced subjective pain and tear symptoms.   Two RCTs and observational studies were included for LASIK surgery (see Table S3, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). Postoperative pain and photophobia were milder in eyes with BCL compared with those without BCL ( P =0.04 and P =0.003, respectively), with fibrotic healing being markedly significant in the eyes with BCL compared with control eyes ( P <0.001) at 6 months. The visual acuity was worse in the eyes with BCL (removed 1 day after surgery) compared with control eyes on the first postoperative day but was similar after 6 months. BCL after LASIK surgery showed improvement in pain scores ( P <0.05) and epithelial recovery ( P <0.05), better epithelial improvement ( P <0.05), lesser discomfort ( P <0.05), and faster corneal healing with a wear time of 7 days compared with no BCL.   Table S4, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the characteristics and outcomes of BCL usage after SMILE surgery. An RCT on BCL application after SMILE observed the highest symptom score after 2 hr of surgery, which declined at 4, 8, and 24 hr in three patient groups. At 2 hr after surgery, statistically significant lower symptom scores were reported with groups A and B ( P =0.012 and P =0.020, respectively) compared with group C, whereas no difference between groups A and B was observed ( P =0.814). Scores reduced faster in group C compared with groups A and B from 2 to 4 hr after surgery, whereas no difference between groups was observed at other time points. The effect of BCL on other outcomes such as blurred vision, photophobia, tearing, corneal edema, and UCVA was reported.   Two RCTs and four observational studies were included in the study. The outcomes of BCL usage after cataract surgery are summarized in Table S5, Supplemental Digital Content, http://links.lww.com/ICL/A272 . All six studies compared eyes with BCL with either eye treated with usual care, which consisted of local antibiotic therapy combined with an eye pad or only antibiotic therapy. The wear time of BCLs by patients from three studies , , was 7 days after surgery. A study by Chen et al. showed statistically significant improvements in Ocular Surface Disease Index scores at 1 week ( P <0.001) and 14 days after surgery ( P <0.001) in the BCL eye compared with the untreated eye. Similarly, subjective evaluation scores, tear film break-up time, and fluorescein staining improved at week 1 ( P =0.031, P =0.021, and P =0.03, respectively) and day 14 ( P =0.009, P =0.021, and P =0.032, respectively) in the BCL eye compared with the untreated eye. Lipid tear dysfunction (NIf-BUT; P =0.008), bulbar redness ( P =0.047), and Schirmer I test score ( P =0.013) showed significant improvement with BCL at 1 month after surgery with reduced inflammation, whereas the tear break-up time ( P <0.001) and corneal fluorescein score ( P =0.004) improved rapidly in eyes with BCL compared with those with eye pads 3 months after surgery. Patient satisfaction scores were higher in the BCL group compared with the eyepatch group (8.38±1.59 vs 7.63±1.75; P =0.213), whereas lower corneal fluorescein staining scores ( P <0.05) were observed 3 days after surgery with BCL. The pain scores improved within 8 hr ( P <0.05) and 3 days ( P <0.05) in the BCL group compared with the control group.   Table S6, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the main outcomes of BCL usage after CXL surgery. One RCT and one observational study were included in the study. Balafilcon A and hioxifilcon A lenses reduced pain, eyelid edema, conjunctival hyperemia, irritation, and burning on the third postoperative day compared with the first postoperative day. Complete corneal re-epithelialization was observed after 3 days in both groups after which lenses were removed from the patient's eyes. Similar results were observed with lotrafilcon B (24, 60). Decreased pain scores from the first (4.61±2.3 and 4.06±2.2, respectively) to the third postoperative day (0.91±1.43 and 4.06±2.2, respectively) were observed in the balafilcon and lotrafilcon B groups. The BCL usage reduced epithelial defect size considerably from the first to the third postoperative day. Epithelial defect size was smaller in the lotrafilcon B group compared with the balafilcon A group on day 1 ( P <0.001) and day 2 ( P =0.039).   Three RCTs and two observational studies were included in the study (see Table S7, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). Balafilcon A (n=4), senofilcon A (n=1), and lotrafilcon A (n=1) were used for postvitrectomy treatment with a wear time varying from 1 to 7 days. Corneal fluorescein staining score was 0.61±0.62 with senofilcon A lens and 1.81±1.26 in eyes without BCL on the first postoperative day ( P =0.003), whereas no difference in corneal fluorescein sodium staining positive rate was observed between the lotrafilcon A and balafilcon A groups ( P =0.848) at seventh postoperative day. Ocular irritation ( P <0.05) and ocular pain ( P <0.05) improved significantly in the patient eyes with balafilcon A compared with the no BCL group on the seventh postoperative day. The BCL usage improved epithelial defect ( P =0.0002) on 14th postoperative day and improved tearing ( P =0.005) and reduced pain on seventh postoperative day compared with the no BCL group. A retrospective study observed that BCL could effectively treat corneal epithelium defects after vitrectomy. Maximum benefit was observed on the 14th postoperative day. This systematic review summarizes studies reporting the immediate use of BCLs in postoperative care for ocular surgeries using published evidence. We have reviewed the performance of five BCL materials applied after different types of ocular surgeries to understand the beneficial patient profiles and optimal wear time associated with maximal benefits specific to each surgery (Table ). The use of BCLs has been recognized to offer benefits after ocular surgery (Table ).   Photorefractive Keratectomy PRK is a refractive surgical ablation performed on the corneal surface after epithelial debridement. Bandage contact lenses are known to relieve postoperative PRK side effects and facilitate faster re-epithelization of the cornea with improved wound healing, thus accelerating visual rehabilitation. The pain intensity is known to peak at 24 to 72 hr after the PRK procedure, which then decreases through day 5. – Another study on postoperative care in corneal refractive surgery showed that pain peaked during the first 24 hr with a median duration of 3 days. Approximately 52% of patients recorded a higher pain score of greater than 7 during these 3 days. This review showed that the application of BCLs reduced early postoperative pain (day 1), whereas a notable reduction in pain response was observed on the third postoperative day with negligent pain response observed on the fourth day after PRK (see Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). The removal of BCLs either on the third day after surgery or later did not affect the duration of the reduction in pain response. , Other studies observed that exchanging BCL every day after surgery minimized early postoperative pain. In most of the studies after PRK, the postoperative medication regimen included the use of topical antibiotics, steroids, and/or nonsteroidal anti-inflammatory drugs (NSAIDs) (see Table S9, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). In two studies, NSAID was applied during the procedure before BCL. , Postoperative moxifloxacin – , , was widely used among other antibiotics. The studies reported uniform administration of postoperative medication regimens such as antibiotics, steroids (betamethasone, loteprednol, prednisolone, and fluorometholone), NSAIDs (diclofenac, nepafenac, and ketorolac), and opioids (in few studies) were applied to both eyes including control or between comparisons of BCLs eyes after PRK. – Among other outcomes, epiphora scores and comfort scores improved by day 3 after surgery on BCL application, whereas photophobia scores and foreign body sensation decreased by the third day after surgery. , , , , Pain is known to subside when re-epithelialization of the cornea is completed. , After PRK, the corneal surface is known to regenerate in 3 to 4 days. Bandage contact lenses reduce epithelial defect size considerably on the third postoperative day compared with the first postoperative day with maximum benefits observed with lotrafilcon B (41) among the selected BCLs for the study. Complete re-epithelialization was observed in 72.7% to 83% of patients within 3.1–3.6 days with different BCLs. Bandage contact lenses are often removed after the completion of re-epithelialization of the cornea after PRK. Proper re-epithelialization facilitates improved visual acuity after 1 month of surgery. , Removal of BCL 7 days after surgery improves visual acuity at 1 month compared with the removal of BCL on the fourth day after surgery. Table S8, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the benefits associated with types of BCLs with limited studies focusing on long-term benefits. , , , – Future clinical trials are warranted to understand the effect of BCLs on all visual outcomes associated with PRK. Findings from most studies related to PRK, irrespective of BCL material used, suggest that wear time of 3–4 days after surgery will yield maximum benefits in managing postoperative symptoms and facilitation of early rehabilitation. The risk of infections is also low with BCL usage. Although the study by Mohammadpour et al. suggested that wearing BCLs for 7 days after surgery will reap maximum visual benefits, more studies need to be conducted to validate the results. Other Postcorneal Refractive Surgeries Laser Epithelial Keratomileusis Surgery After LASEK surgery, BCL application is known to protect the corneal wound and relieves patient discomfort. LASEK surgeries are known to cause pain in the first few hours with minimal or no pain at 24 hr. The beneficial effect of shorter corneal epithelial healing time (4.07 days), lesser discomfort, and more improvement in unaided eye vision was observed with 4 to 6 days of BCL wearing time. Late-onset shedding of corneal epithelium was not observed with BCL. In addition, BCL application reduced postoperative symptoms such as pain, photophobia, foreign body sensation, and tear score in patients who underwent LASEK surgery. Decreased pain, tearing, and sensation of dryness were observed on day 3 after surgery; negligible pain response, tearing, and sensation of dryness were observed on day 7 after surgery. These outcomes depict the beneficial effect of BCL usage after LASEK within a wear time of 5 days. The beneficial time was similar for the two BCL materials used in these studies. Laser-Assisted In Situ Keratomileusis Surgery After LASIK surgeries, along with the other beneficial effects that BCL has after refractive surgeries, BCL is also known to reduce the intense fibrotic wound healing response at the flap margins after LASIK. LASIK surgeries are also known to cause pain in the first few hours with minimal or no pain at 24 hr. BCL wear time of 1 day after surgery improved pain, photophobia, tear reduction, and fibrotic healing of FLAP ; 3-day wear time improved dry eye parameters and tear-film breakup time 1 month after the surgery, whereas fast corneal healing with good visual acuity outcomes was observed with 7 days of BCL wear time after LASIK. Furthermore, day and night wearable corneal contact lenses (silicone hydrogel) with higher DK/L (110×10 −9 barrer/mm) permit high oxygen transmissibility and showed significant improvement in epithelial healing for 4 to 7 days. Milder postoperative symptoms with greater improvement in pain response and corneal epithelial healing were observed during the 7-day postoperative BCL wear. , These findings indicate that 7-day post-LASIK BCL wearing time would reap maximum benefits. Small Incision Lenticule Extraction Surgery The only study on post-SMILE surgery treatment demonstrated the beneficial effects of wearing senofilcon A with reduced symptoms of tearing and pain 2 hr after the surgery as well as a reduction in corneal edema at 24 hr after the surgery with a BCL wear time of 8 and 24 hr after surgery compared with no BCL. A beneficial BCL wear time of 8 hr after surgery can be recommended, although more studies are required to validate the same.   PRK is a refractive surgical ablation performed on the corneal surface after epithelial debridement. Bandage contact lenses are known to relieve postoperative PRK side effects and facilitate faster re-epithelization of the cornea with improved wound healing, thus accelerating visual rehabilitation. The pain intensity is known to peak at 24 to 72 hr after the PRK procedure, which then decreases through day 5. – Another study on postoperative care in corneal refractive surgery showed that pain peaked during the first 24 hr with a median duration of 3 days. Approximately 52% of patients recorded a higher pain score of greater than 7 during these 3 days. This review showed that the application of BCLs reduced early postoperative pain (day 1), whereas a notable reduction in pain response was observed on the third postoperative day with negligent pain response observed on the fourth day after PRK (see Table S2, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). The removal of BCLs either on the third day after surgery or later did not affect the duration of the reduction in pain response. , Other studies observed that exchanging BCL every day after surgery minimized early postoperative pain. In most of the studies after PRK, the postoperative medication regimen included the use of topical antibiotics, steroids, and/or nonsteroidal anti-inflammatory drugs (NSAIDs) (see Table S9, Supplemental Digital Content, http://links.lww.com/ICL/A272 ). In two studies, NSAID was applied during the procedure before BCL. , Postoperative moxifloxacin – , , was widely used among other antibiotics. The studies reported uniform administration of postoperative medication regimens such as antibiotics, steroids (betamethasone, loteprednol, prednisolone, and fluorometholone), NSAIDs (diclofenac, nepafenac, and ketorolac), and opioids (in few studies) were applied to both eyes including control or between comparisons of BCLs eyes after PRK. – Among other outcomes, epiphora scores and comfort scores improved by day 3 after surgery on BCL application, whereas photophobia scores and foreign body sensation decreased by the third day after surgery. , , , , Pain is known to subside when re-epithelialization of the cornea is completed. , After PRK, the corneal surface is known to regenerate in 3 to 4 days. Bandage contact lenses reduce epithelial defect size considerably on the third postoperative day compared with the first postoperative day with maximum benefits observed with lotrafilcon B (41) among the selected BCLs for the study. Complete re-epithelialization was observed in 72.7% to 83% of patients within 3.1–3.6 days with different BCLs. Bandage contact lenses are often removed after the completion of re-epithelialization of the cornea after PRK. Proper re-epithelialization facilitates improved visual acuity after 1 month of surgery. , Removal of BCL 7 days after surgery improves visual acuity at 1 month compared with the removal of BCL on the fourth day after surgery. Table S8, Supplemental Digital Content, http://links.lww.com/ICL/A272 summarizes the benefits associated with types of BCLs with limited studies focusing on long-term benefits. , , , – Future clinical trials are warranted to understand the effect of BCLs on all visual outcomes associated with PRK. Findings from most studies related to PRK, irrespective of BCL material used, suggest that wear time of 3–4 days after surgery will yield maximum benefits in managing postoperative symptoms and facilitation of early rehabilitation. The risk of infections is also low with BCL usage. Although the study by Mohammadpour et al. suggested that wearing BCLs for 7 days after surgery will reap maximum visual benefits, more studies need to be conducted to validate the results.   Laser Epithelial Keratomileusis Surgery After LASEK surgery, BCL application is known to protect the corneal wound and relieves patient discomfort. LASEK surgeries are known to cause pain in the first few hours with minimal or no pain at 24 hr. The beneficial effect of shorter corneal epithelial healing time (4.07 days), lesser discomfort, and more improvement in unaided eye vision was observed with 4 to 6 days of BCL wearing time. Late-onset shedding of corneal epithelium was not observed with BCL. In addition, BCL application reduced postoperative symptoms such as pain, photophobia, foreign body sensation, and tear score in patients who underwent LASEK surgery. Decreased pain, tearing, and sensation of dryness were observed on day 3 after surgery; negligible pain response, tearing, and sensation of dryness were observed on day 7 after surgery. These outcomes depict the beneficial effect of BCL usage after LASEK within a wear time of 5 days. The beneficial time was similar for the two BCL materials used in these studies. Laser-Assisted In Situ Keratomileusis Surgery After LASIK surgeries, along with the other beneficial effects that BCL has after refractive surgeries, BCL is also known to reduce the intense fibrotic wound healing response at the flap margins after LASIK. LASIK surgeries are also known to cause pain in the first few hours with minimal or no pain at 24 hr. BCL wear time of 1 day after surgery improved pain, photophobia, tear reduction, and fibrotic healing of FLAP ; 3-day wear time improved dry eye parameters and tear-film breakup time 1 month after the surgery, whereas fast corneal healing with good visual acuity outcomes was observed with 7 days of BCL wear time after LASIK. Furthermore, day and night wearable corneal contact lenses (silicone hydrogel) with higher DK/L (110×10 −9 barrer/mm) permit high oxygen transmissibility and showed significant improvement in epithelial healing for 4 to 7 days. Milder postoperative symptoms with greater improvement in pain response and corneal epithelial healing were observed during the 7-day postoperative BCL wear. , These findings indicate that 7-day post-LASIK BCL wearing time would reap maximum benefits. Small Incision Lenticule Extraction Surgery The only study on post-SMILE surgery treatment demonstrated the beneficial effects of wearing senofilcon A with reduced symptoms of tearing and pain 2 hr after the surgery as well as a reduction in corneal edema at 24 hr after the surgery with a BCL wear time of 8 and 24 hr after surgery compared with no BCL. A beneficial BCL wear time of 8 hr after surgery can be recommended, although more studies are required to validate the same.   After LASEK surgery, BCL application is known to protect the corneal wound and relieves patient discomfort. LASEK surgeries are known to cause pain in the first few hours with minimal or no pain at 24 hr. The beneficial effect of shorter corneal epithelial healing time (4.07 days), lesser discomfort, and more improvement in unaided eye vision was observed with 4 to 6 days of BCL wearing time. Late-onset shedding of corneal epithelium was not observed with BCL. In addition, BCL application reduced postoperative symptoms such as pain, photophobia, foreign body sensation, and tear score in patients who underwent LASEK surgery. Decreased pain, tearing, and sensation of dryness were observed on day 3 after surgery; negligible pain response, tearing, and sensation of dryness were observed on day 7 after surgery. These outcomes depict the beneficial effect of BCL usage after LASEK within a wear time of 5 days. The beneficial time was similar for the two BCL materials used in these studies.   After LASIK surgeries, along with the other beneficial effects that BCL has after refractive surgeries, BCL is also known to reduce the intense fibrotic wound healing response at the flap margins after LASIK. LASIK surgeries are also known to cause pain in the first few hours with minimal or no pain at 24 hr. BCL wear time of 1 day after surgery improved pain, photophobia, tear reduction, and fibrotic healing of FLAP ; 3-day wear time improved dry eye parameters and tear-film breakup time 1 month after the surgery, whereas fast corneal healing with good visual acuity outcomes was observed with 7 days of BCL wear time after LASIK. Furthermore, day and night wearable corneal contact lenses (silicone hydrogel) with higher DK/L (110×10 −9 barrer/mm) permit high oxygen transmissibility and showed significant improvement in epithelial healing for 4 to 7 days. Milder postoperative symptoms with greater improvement in pain response and corneal epithelial healing were observed during the 7-day postoperative BCL wear. , These findings indicate that 7-day post-LASIK BCL wearing time would reap maximum benefits.   The only study on post-SMILE surgery treatment demonstrated the beneficial effects of wearing senofilcon A with reduced symptoms of tearing and pain 2 hr after the surgery as well as a reduction in corneal edema at 24 hr after the surgery with a BCL wear time of 8 and 24 hr after surgery compared with no BCL. A beneficial BCL wear time of 8 hr after surgery can be recommended, although more studies are required to validate the same.   After cataract surgeries, BCLs are known to act as a sealant and improve dry eye syndrome in addition to managing postoperative symptoms. The beneficial BCL wear time of 7 days was observed in most studies except for the study by Xin et al., in which the wear time was 3 days irrespective of the BCL material used. Higher patient satisfaction scores were observed by Jing et al. Improved tear film stability and less dry eye discomfort were observed at 7 days after surgery. The dry eye–related parameters such as stabilization of ocular surface, tear film, inflammation, and corneal healing improved significantly after 1 month. Comfort and tear film stability improved by 7 days and remained the same till 3 months. Early BCL benefits were observed with pain symptoms being reduced as early as 8 hr after surgery and maintained till 3 days, whereas faster corneal epithelial healing was observed at 3 days after surgery. These findings emphasize the benefits of BCL as early as 8 hr until 3 months, alleviating postoperative symptoms and aiding visual rehabilitation with an optimal wear time of 7 days.   Studies on post-CXL surgery treatment were conducted in Turkey with a BCL wear time of 3 days in patients with keratoconus. Corneal re-epithelialization was completed in 3 days, , and a decrease in pain was observed from the first to third postoperative day. The complete re-epithelialization time ranged from 3.33 to 3.41 days for BCLs.   All studies were from China involving patients with diabetic retinopathy. Improved ocular irritation, lacrimation, and reduced corneal epithelial loss were observed at 7 days of BCL usage. Corneal moist improved with a BCL wear time of 1 day after surgery, whereas corneal integrity after surgery was maintained with a wear time of 7 days. Epithelial defect size was lesser with BCL at 14 days after surgery. BCL is beneficial in comfort, corneal epithelium healing, and visual acuity after vitrectomy surgery with maximum benefit observed at 7 days, whereas visual acuity benefit was observed at 3 months after surgery with 7 days of wear time. To summarize, BCL can be used as effective bandages after corneal refractive, cataract, and vitrectomy surgeries, providing pain relief, reducing postoperative symptoms, and promoting re-epithelialization of the cornea with healing in the early postoperative phase. In addition, BCL improved dry eye symptoms and ocular surface in postcataract surgery. Depending on the type of surgery, patients are recommended to wear BCL immediately after surgery for 8 hr or to 7 days to maximize the beneficial effects. The beneficial wear time for maximum clinical benefits was similar for most BCL materials as observed in most posteye surgeries. Recommendations for timely BCL application immediately after different eye surgeries and its clinical benefits are summarized in Table .   