Tobramycin

All procedures were performed under topical anesthesia. The center of the pupil was marked, and a disposable suction ring was centered on the pupil. A channel was subsequently created with a femtosecond laser (Wavelight FS 200, Alcon Laboratories, Inc., Fortworth, TX, USA) at 75% of the thickness of the cornea. The incision was performed on the steepest keratometry axis. The laser software was programmed according to the ICRS type, with a 5 mm diameter ring requiring an inner diameter of 4.4 mm and an outer diameter of 5.7 mm. The channel and incision were created with an energy of 1.20 mJ. ICRSs were implanted with dedicated forceps under fully aseptic conditions. The segments were set in their final positions with the aid of a Sinskey hook. Postoperative treatment consisted of combined antibiotic (tobramycin, 3 mg/mL) and steroid (dexamethasone, 1 mg/mL) eye drops (Tobradex; Alcon Laboratories Inc., Fort Worth, TX, USA) administered three times daily for two weeks and eye lubricant (Vismed, Horus Pharma, France) for one month after surgery.

All surgical procedures were performed under general anesthesia (i.p. 75 mg/kg body weight ketamine, Anesketin, Eurovet; i.p. 1 mg/kg medetomidine, Domitor, Pfizer). After the procedure, anesthesia was reversed by means of atipamezole (i.p. 1 mg/kg, Antisedan, Pfizer), and antibiotic ointment (tobramycin 3 mg/g, Tobrex, Alcon) was applied to avoid corneal desiccation and infection of the eye. In order to exclude contralateral effects, which have been reported, for example, for GFAP expression and microglia reactivity [34 (link)–36 (link)], untreated eyes from a separate cohort of untreated animals served as controls.

This randomized controlled trial was the parallel group, two-armed trial with 1:1 allocation ratio. The treatment assignment was performed using the block-of-six randomization based on computer-generated random numbers. The assignment letters were sequentially concealed in the sealed and opaque envelopes by two investigators (AN and SB). After an uneventful surgery, an investigator (KS) disclosed the treatment assignment to the surgeon. The patients were randomly received whether subtenon triamcinolone injection (TA group) or topical dexamethasone eye drop (Dexa group). In the TA group, the patients received a 20-mg triamcinolone acetonide subtenon injection intraoperatively. To mask the patients and to prevent postoperative infection, both groups received 20-mg gentamicin subconjunctival injection at the end of the surgery.
Postoperatively, the patients in TA group received 0.3% tobramycin eye drop (Tobrex®, Alcon, Fort Worth, Texas, USA) 4 times a day for 28 days. In the Dexa group, the patient received a combined 0.1% dexamethasone/0.3% tobramycin eye drop (Tobradex®, Alcon, Fort Worth, Texas, USA) 4 times a day for 28 days starting at the first postoperative day. The investigators (PC, WN, KM) performed the clinical evaluations and flare-cell metering without knowing the patient's information and the treatment assigned.