Efficacy of 0.05% cyclosporine A on the lipid layer and meibomian glands after cataract surgery: A randomized, double-masked study

Abstract

Purpose To quantitatively evaluate the effects of 0.05% cyclosporine A (CsA) on lipid layer thickness (LLT) and meibomian glands after cataract surgery using the LipiView® ocular surface interferometer. Methods This study was a prospective randomized double-masked clinical trial conducted by Pusan National University Yangsan Hospital between April 04, 2019, and November 31, 2019. Sixty-two participants were recruited, and 12 of them were not enrolled because they had undergone previous treatments for ocular surface diseases. The participants were adult patients with cataract, exhibiting normal lid position; they did not present any other ocular disease and did not meet the exclusion criteria of the clinical trial. Fifty subjects were enrolled in the study. The randomized subjects received treatment with 0.05% CsA (group A) or 0.5% carboxymethyl cellulose (CMC) (group B) over the 3 months following the cataract surgery. Subjective and objective assessments were performed at preoperative and postoperative visits. Ocular Surface Disease Index (OSDI), tear breakup time (TBUT), and Schirmer’s I test were performed by the same surgeon, and LLT and meiboscore were determined using the LipiView® interferometer. Results Fifty subjects subjects enrolled consisted of men (50%) and women (50%), with a mean (SD) age of 65.94 (10.35) years. Four subjects in group A and five in group B were excluded from the analysis as they were lost to follow-up within 1 month after cataract surgery. Thus, the study comprised 41 eyes of 41 subjects; 21 subjects were treated with CsA and 20 subjects with CMC. Comparing the clinical measurements between groups A and B taken at the last visit, while controlling the effects of the preoperative values, TBUT and LLT showed significant differences (p = 0.035 and p = 0.047, respectively, by ANCOVA). The TBUT between the subjects using CsA and those using CMC after cataract surgery showed a significant difference during follow up (p = 0.003 by repeated measures ANOVA). In the multivariate analysis, preoperative LLT and the use of CsA were found to be independent parameters for postoperative LLT (R2 = 0.303; p = 0.008 and p = 0.045, respectively), whereas the follow-up duration exhibited a positive correlation with the difference between the preoperative and postoperative values of LLT in the group treated with CsA (R2 = 0.738 and p < 0.001). Conclusion Treatment with 0.05% CsA following cataract surgery is effective in improving TBUT and LLT in comparison with 0.5% CMC. A higher preoperative value of LLT and the postoperative use of CsA could be significant determinants of a higher postoperative LLT value. Trial registration ISRCTN registry with ISRCTN 10173448.

Evaluation of cyclosporine 0.05% and artificial tears for the management of dry eye disease following cataract surgery: a randomized controlled trial

“…In line with our results, Kang et al . 31 found a significant improvement in the TBUT score in subjects who received treatment with cyclosporine 0.05% compared with the group treated with 0.5% carboxymethylcellulose. Furthermore, in patients treated with topical lubricants and cyclosporine 0.05%, Ganesh et al .…”

Evaluation of Ocular Surface after Cataract Surgery—A Prospective Study

“…Our results show that dry eye symptoms and ocular surface dysfunction signs are quite common before the cataract surgery, and they only worsen after phacoemulsification. There are a few studies that evaluated medications for dry eye symptoms and signs occurring after the phacoemulsification: trehalose/sodium hyaluronate [ 46 ], trehalose/hyaluronic acid vs. hyaluronic acid [ 47 ], 3% diquafosol [ 48 ], and 0.05% cyclosporine A [ 49 ] which all had positive outcomes.…”

Clinical efficacy of 0.05% cyclosporine nano-emulsion in the treatment of dry eye syndrome associated with meibomian gland dysfunction

“…The efficacy of cyclosporine on LLT has been limitedly investigated. In a previous study, significant improvement in LLT after 3mo of using conventional cyclosporine was reported [39] . This study also showed significant changes occurred after 8wk of treatment with conventional cyclosporine, In contrast, the Nano-cyclosporine group showed statistically significant change in LLT after 4wk.…”