Abstract
Purpose: To assess the efficacy of topical cyclosporine 0.05% in the management of cataract surgery induced dry eye. Methods: This prospective, comparative, randomized, interventional study included 67 patients undergoing cataract surgery. The patients were randomized into three categories Group A: patients on topical lubricants and cyclosporine 0.05%, Group B: patients on topical lubricants only and Group C: patients not on any dry eye medication. Patients were given the respective treatment 2 weeks prior and 3 months after cataract surgery, along with an identical perioperative regimen of topical steroids, antibiotics and NSAIDs. Dry eye evaluation done 2 weeks pre-op, 1 week post-op and 3 months post-op consisted of a subjective questionnaire, tear osmolarity, Tear Break Up Time (TBUT) and Schirmer’s 1 without and with anaesthesia. Results: Pre-operatively, all the 3 groups were matched in terms of mean age, tear osmolarity, TBUT and Schirmer’s 1 without and with anaesthesia scores. At 3 months, patients treated with both topical lubricants and cyclosporine (0.05%)(Group A) showed improvement subjective questionnaire, tear osmolarity, TBUT and Schirmer’s 1 tests. Patients treated with lubricants only (Group B) showed a significant worsening in TBUT and tear osmolarity at 1 week, however, the values returned to baseline at 3 months.The control group (Group C) had the worst TBUT scores at the end of 3 months and showed the persistence of raised tear osmolarity, suggestive of a prolonged ocular inflammation resulting in patient dissatisfaction. Conclusion: Topical cyclosporine (0.05%) may be a useful adjuvant to prevent and treat cataract surgery associated with dry eye symptoms, especially in patients with pre-existing dry eye disease.
Highlights
Various studies have proven that cataract surgery aggravates and causes dry eye and disrupts the normal tear film, whose function is to maintain a healthy ocular surface
There was no significant difference in mean age, gender, eye laterality, tear osmolarity scores, Tear Break Up Time (TBUT), Schirmer’s 1 test without and with anaesthesia between the three study groups (p value > 0.05 for all parameters)
At 1st week, all groups observed worsening in tear osmolarity scores compared to pre, the worsening was statistically significant in group B and C (p= 0.001 for group B and p=0.021 for group C)
Summary
Various studies have proven that cataract surgery aggravates and causes dry eye and disrupts the normal tear film, whose function is to maintain a healthy ocular surface. Optimization of the ocular surface prior to and after cataract surgery is imperative in such patients. Inflammation has been shown to be the key in the pathogenesis of tear film anomalies. Regardless of the triggering factor, a vicious cycle of inflammation consisting of cytokine production, activation of T-lymphocytes further leading to sec-. Cyclosporine A is a fungal-derived peptide that inhibits Tcell activation and inhibits the inflammatory cytokine production (selective inhibition of IL-I). It inhibits apoptosis and increases the density of conjunctival goblet cells [3]. The international task force guidelines for dry eye recommended the use of cyclosporine A for treatment of dry eye and tear film dysfunction [8]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
