Comparison of topical application of cyclosporine A to prednisolone in treatment of dry eye disease

Abstract

Background Dry eye disease (DED) is a common ophthalmic disorder which affects 5–50% of the global population. Aim The aim of this study was to compare the effects of topical application of cyclosporine A (CsA) to prednisolone in patients with DED. Patients and methods The study included 40 patients diagnosed with DED. They were randomly divided into two groups: group A patients received treatment with topical 0.05% CsA twice a day, and group B patients received treatment with topical 1% prednisolone four times a day for 1 month. All patients were examined at three visits: before treatment, after 2 weeks, and 1 month after the intervention to show the effect of the two drugs on the tear break-up time (TBUT), Schirmer’s score, ocular surface disease index (OSDI), and surface stain, in addition to assessment of the patient’s DED-related symptoms. Results In the prednisolone group, the pretreatment Schirmer’s test results were 3.05±1.57 and 2.35±1.57 mm for the right (OD) and left eyes (OS), respectively. It improved to 5.65±2.30 and 5.85±2.43 mm, respectively 2 weeks after discontinuation of treatment (posttreatment). Similarly, the pretreatment values for the CsA group were 1.35±1.57 and 2.0±1.52 mm and became 5.65±2.30 and 5.85±2.434 mm, respectively after treatment. There was a statistically significant difference between the two groups regarding the pretreatment (P=0.001) and posttreatment (P=0.026) Schirmer’s test results. In the prednisolone group, the pretreatment TBUT was 4.20±1.61 and 3.85±1.09 s and improved to 6.60±1.31 and 6.85±1.42 s, respectively after treatment. Similarly, in the CsA group the pretreatment values were 2.65±1.81 and 3.30±1.38 s and became 8.65±1.69 and 9.30±1.42 s, respectively, posttreatment. In addition, there was a statistically significant difference between the studied groups regarding the pretreatment (P=0.007) and posttreatment TBUT (P<0.001). The pretreatment OSDI, in the prednisolone group, was 47.28±5.31 and became 38.00±4.33 posttreatment. Similarly, in the CsA group, the pretreatment value was 49.18±8.69 and became 35.03±8.04 posttreatment. However, there were no statistically significant differences between the studied groups regarding the pretreatment and posttreatment OSDI (P>0.05). The surface stain improved in both groups after treatment, with the prednisolone group showing the greatest improvement at 2 weeks (P=0.002). However, there was no statistically significant difference between the two groups at 1 month (P>0.05). Conclusion Both topical CsA and prednisolone demonstrated effectiveness in treating moderate to severe DED cases and were comparable. Prednisolone showed a greater improvement in OSDI (that assesses the DED-related symptoms) and surface stain, while CsA was associated with more improvement in Schirmer’s test and TBUT.