With a sterile drape, the eyelashes were drawn back, the eye was covered, and a blepharostat
After separating the eyelids with a blepharostat
and applying the anaesthesia, the procedure began with the instillation, every 90 seconds for a total of 4 minutes, of dextranfree hypoosmolar riboflavin drops containing agents to improve the epithelial permeability, including benzalkonium chloride (Paracel, Avedro, Waltham, MA, United States).
Eyes remained open by placing blepharostat
and the cornea was irrigated with saline using an anterior chamber cannula.
Intraoperative analgesia was assessed on a numerical scale ranging from 0 to 10, before injection of the solution, after 5 and 15 minutes, blepharostat
placement, incision of the cornea, capsulorhexis, phacoemulsification, irrigation and aspiration, and lens implantation, and at the end of surgery.
After instillation of topical anesthetic drops on patient's eye, lids were ruled out with blepharostat
or lid speculum.