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Dr. Chynn on NSAID effects on overcorrections post PRK

Comment from another MD

Evan’s post  was asking “anyone had issues with poor epithelial healing (or even corneal melting) with Besivance”.  My response is based on my clinical referral practice and the attached document.

Please note this section from the attached document:

These medications contain vehicles that have the potential to be sequestered beneath a LASIK flap or a bandage contact lens following PRK and not absorbed.  The ASCRS Cornea and Refractive Surgery Clinical Committees have become aware of several cases of flap slippage and/or diffuse lamellar keratitis (DLK) following LASIK when topical ophthalmic medications with these advanced vehicles have been instilled immediately prior to LASIK or intraoperatively while the flap has been elevated.  There have been no problems documented with the use of these medications after the flap has been properly positioned.  There have also been documented cases of poor epithelial healing when topical ophthalmic medications with these advanced vehicles have been instilled on the stromal bed following PRK prior to placement of a bandage contact lens. 

I have bolded the section that was relevant to my post.  Emil, I think there may a significant difference in wound healing between LASEK and the epi defect in PRK.  In any event, I do not use Besivance in the presence of an epithelial defect.


Dr. Chynn’s answer

There’s no difference, because I’m no longer putting flaps back. So what I’m calling a LASEK others might call an alcohol-assisted PRK
In my humble opinion, after having performed more surface ablations than anyone else on this forum, it’s not “cautious” to advise people not to use Besivance after PRK. It’s bad advice, BC as long as you stick the drop ON TOP OF the BCL rather than UNDER it there’s no delayed healing. Period!
Or would you say I need to do 3,000 ASAs w Besivance before I’m sure about this point?
What evidence does anyone have of delayed healing after PRK when you stick B properly on top of the BCL rather than improperly below it?
Seems like none
So how’s it scientific to recommend against something when you have 0 cases demonstrating your “point of view” and I have 2000 cases demonstrating that it is safe when properly dosed and applied?
Same problem of over-generalization that “NSAIDs can cause corneal melts so bad they might lead to perforation”
That problem was probably due to a particular brand of generic NSAID, probably the carrier/vehicle, that was quickly removed from the market
Now because of this bad over-generalization people are scared of QID dosing of NSAIDs for more than a week
Well, I’ve dosed NSAIDs at QID for MONTHS post ASA to regress HUNDREDS of over corrections, and that does work, can cause permanent epithelial hyperplasia (or more properly hyperplasia to a normal thickness as “over-responders” after ASA are probably “under-healers” who’s epithelium grows back thinner than normal). So you can get rid of up to +1D wo further surgery"</p


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