Cyclosporine superior to artificial tears for treating dry eye after cataract surgery

BySara Kellner

Fact checked byHeather Biele

Key takeaways:

Cyclosporine 0.05% conferred significantly higher tear breakup time compared with artificial tears.
Schirmer’s values and VAS scores did not show statistically significant differences.

Perspective from Nathan Garlick, OD, FAAO

Cyclosporine 0.05% outperformed artificial tears in improving tear film quality and stability in the treatment of dry eye disease after cataract surgery, according to a study published in Annals of Medicine & Surgery.

“Previous studies have determined different management strategies for dry eyes using cyclosporine 0.05% or artificial tears,” Hanieh Ahmadi, MD, a faculty member in the department of ophthalmology at Bu-Ali Sina Hospital in Iran, and colleagues wrote. “However, direct comparisons of the clinical efficacy of cyclosporine in enhancing tear secretion and artificial tears in increasing tear volume for the treatment of dry eye after cataract surgery have rarely been reported.”

Eye drops 630x1200 — Cyclosporine 0.05% was more effective than artificial tears in improving tear stability after cataract surgery. *Image: Adobe Stoc*k

The prospective, double-masked randomized trial included 60 eyes from 60 patients (women, n = 32; mean age, 64.15 ± 9.17 years, range 45-90 years) with cataracts. Following cataract surgery, patients were prescribed either cyclosporine 0.05% or artificial tears, administered four times daily, for dry eye disease management.

After 1 month, researchers assessed each treatment through tear breakup time, Schirmer’s tests and a visual analogue scale (VAS) questionnaire. Secondary assessments included refraction and corrected and uncorrected distance visual acuity.

The cyclosporine group had significantly higher mean TBUT than the artificial tear group (P = .004), but there were no statistically significant differences in mean Schirmer’s values or VAS responses. These findings persisted after the researchers adjusted for type of cataract, age and sex.

There also were no visual acuity or spherical equivalent differences between the groups.

“This study demonstrates the beneficial effect of cyclosporine in reducing dry eye symptoms after cataract surgery due to its anti-inflammatory properties and improvement in tear secretion,” the researchers wrote. “Our findings suggest that cyclosporine may have additional benefits over artificial tears, particularly an improvement in TBUT and its potential to improve tear film stability.”

Perspective

Nathan Garlick, OD, FAAO

While this study found that 0.05% cyclosporine provided superior dry eye relief compared with artificial tears for post-cataract surgery patients, eye care providers should use caution in broader application to other causes and symptoms of dry eye. The study only included patients without pre-existing dry eye conditions prior to cataract surgery, and the only measure of dry eye that was significantly improved by cyclosporine was the patients’ TBUT values. Thus, cyclosporine may have limited application for treatment of evaporative dry eye symptoms and tear film stabilization outside cataract surgery context, but further research is needed for broader application, especially in patients with complicated ocular and systemic comorbid conditions. In patients dealing with aqueous deficiency, meibomian gland dysfunction, blepharitis, hormone imbalances or autoimmune conditions, dry eye disease should be treated with industry-standard and accepted means until additional research can further vouch for the efficacy of cyclosporine outside the post-cataract surgery window.

Nathan Garlick, OD, FAAO

Active duty

U.S. Naval Hospital

Okinawa, Japan

This perspective is powered by the American Academy of Optometry's Communications Committee.

Disclosures: Garlick reports no relevant financial disclosures.

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Source:

Ahmadi H, et al. Ann Med Surg 2024:doi:10.1097/MS9.0000000000001795.

Disclosures: The authors report no relevant financial disclosures.

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Cyclosporine superior to artificial tears for treating dry eye after cataract surgery

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