Effect of 0.1% Sodium Hyaluronate and 0.05% Cyclosporine on Tear Film Parameters after Cataract Surgery

Won Choi; Kyung-Chul Yoon

doi:10.3341/jkos.2011.52.7.800

Journal List > J Korean Ophthalmol Soc > v.52(7) > 1009078

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Choi and Yoon: Effect of 0.1% Sodium Hyaluronate and 0.05% Cyclosporine on Tear Film Parameters after Cataract Surgery

Original Article

J Korean Ophthalmol Soc 2011;52(7):800-806.

Published online: 7 September 2011

DOI: https://doi.org/10.3341/jkos.2011.52.7.800

Effect of 0.1% Sodium Hyaluronate and 0.05% Cyclosporine on Tear Film Parameters after Cataract Surgery

Won Choi, MD, Kyung-Chul Yoon, MD, PhD

Department of Ophthalmology, Chonnam National University Medical School, Gwang-ju, Korea

Address reprint requests to Kyung-Chul Yoon, MD, PhD Department of Ophthalmology, Chonnam National University Hospital #671 Jebong-ro, Dong-gu, Gwang-ju 501-757, Korea Tel: 82-62-220-6742, Fax: 82-62-227-1642, E-mail: kcyoon@chonnam.ac.kr

Received 4 October 2010 Revised 13 December 2010 Accepted 12 April 2011

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

To evaluate the efficacy of topical 0.1% sodium hyaluronate (HA) and 0.05% cyclosporine A (CsA) on tear film parameters after cataract surgery.

Methods

A total of 109 eyes of 86 patients who underwent cataract surgery were divided into four groups: 74 eyes without dry eye syndrome (groups 1 and 2) and 35 eyes with dry eye syndrome (groups 3 and 4). Groups 1 (37 eyes) and 3 (17 eyes) used 0.1% HA only, while Groups 2 (37 eyes) and 4 (18 eyes) used both 0.1% HA and 0.05% CsA. Tear film breakup time (BUT), Schirmer's test, tear clearance rate (TCR) and keratoepitheliopathy were evaluated before surgery and 1 week, 1 month, 2, 3 and 6 months after surgery.

Results

BUT, Schirmer's test and TCR recovered at postoperative 3 months in groups 1 and 3, after 2 months in group 2 and after 1 month in group 4. Keratoepitheliopathy recovered at postoperative 1 month in groups 1, 2 and 4, after 2 months in group 3.

Conclusions

The combined use of topical 0.1% HA with 0.05% CsA is helpful in restoring tear film parameters after cataract surgery especially in patients with dry eye syndrome.

Keywords: Cataract operation, Cyclosporine, Sodium hyaluronate, Tear film parameters

References

1. The definition of classification of dry eye diseases: report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop (2007). Ocul Surf. 2007; 5:75–92.

2. Horwath-Winter J, Vidic B, Schwantzer G, Schmut O. Early changes in corneal sensation, ocular surface integrity, and tear-film function after laser-assisted subepithelial keratectomy. J Cataract Refract Surg. 2004; 30:2316–21.

3. Li XM, Hu L, Hu J, Wang W. Investigation of dry eye disease and analysis of the pathogenic factors in patients after cataract surgery. Cornea. 2007; 26(9 Suppl 1):S16–20.

4. Pflugfelder SC, Solomon A, Stern ME. The diagnosis and management of dry eye: a twenty-five-year review. Cornea. 2000; 19:644–9.

5. Nussenblatt RB, Palestine AG. Cyclosporine: immunology, pharmacology and therapeutic uses. Surv Ophthalmol. 1986; 31:159–69.

6. Hemady R, Tauber J, Foster CS. Immunosuppressive drugs in immune and inflammatory ocular disease. Surv Ophthalmol. 1991; 35:369–85.

7. Jabs DA, Wingard J, Green WR, et al. The eye in bone marrow transplantation. III. Conjunctival graft-vs-host disease. Arch Ophthalmol. 1989; 107:1343–8.

8. Bhan AK, Fujikawa LS, Foster CS. T-cell subsets and Langerhans cells in normal and diseased conjunctiva. Am J Ophthalmol. 1982; 94:205–12.

9. Gilbard JP, Rossi SR, Azar DT, Heyda KG. Effect of punctal occlusion by Freeman silicone plug insertion on tear osmolarity in dry eye disorders. CLAO J. 1989; 15:216–8.

10. Lee EH, Jang JW, Lew HM. The changes of tear osmolarity and protein after silicone punctal plug insertion in dry eye. J Korean Ophthalmol Soc. 2001; 42:1509–14.

11. Yen MT, Pflugfelder SC, Feuer WJ. The effect of punctal occlusion on tear production, tear clearance, and ocular surface sensation in normal subjects. Am J Ophthalmol. 2001; 131:314–23.

12. Pflugfelder SC, De Paiva CS, Villarreal AL, Stern ME. Effects of sequential artificial tear and cyclosporine emulsion therapy on conjunctival goblet cell density and transforming growth factor-beta2 production. Cornea. 2008; 27:64–9.

13. Wilson SE, Perry HD. Long-term resolution of chronic dry eye symptoms and signs after topical cyclosporine treatment. Ophthalmology. 2007; 114:76–9.

14. Roberts CW, Carniglia PE, Brazzo BG. Comparison of topical cyclosporine, punctal occlusion, and a combination for the treatment of dry eye. Cornea. 2007; 26:805–9.

15. Raphael M, Bellefqih S, Piette JC, et al. Conjunctival biopsy in Sjögren's syndrome: correlations between histological and immunohistochemical features. Histopathology. 1988; 13:191–202.

16. Kunert KS, Tisdale AS, Stern ME, et al. Analysis of topical cyclosporine treatment of patients with dry eye syndrome: effect on conjunctival lymphocytes. Arch Ophthalmol. 2000; 118:1489–96.

17. O'Brien PD, Collum LM. Dry eye: diagnosis and current treatment strategies. Curr Allergy Asthma Rep. 2004; 4:314–9.

18. Small DS, Acheampong A, Reis B, et al. Blood concentrations of cyclosporin a during long-term treatment with cyclosporin a ophthalmic emulsions in patients with moderate to severe dry eye disease. J Ocul Pharmacol Ther. 2002; 18:411–8.

19. Laibovitz RA, Solch S, Andriano K, et al. Pilot trial of cyclosporine 1% ophthalmic ointment in the treatment of keratoconjunctivitis sicca. Cornea. 1993; 12:315–23.

20. Turner K, Pflugfelder SC, Ji Z, et al. Interleukin-6 levels in the conjunctival epithelium of patients with dry eye disease treated with cyclosporine ophthalmic emulsion. Cornea. 2000; 19:492–6.

21. Stevenson D, Tauber J, Reis BL. Efficacy and safety of cyclosporin A ophthalmic emulsion in the treatment of moderate-to-severe dry eye disease: a dose-ranging, randomized trial. The Cyclosporin A Phase 2 Study Group. Ophthalmology. 2000; 107:967–74.

22. Moon JW, Lee HJ, Shin KC, et al. Short term effects of topical cyclosporine and viscoelastic on the ocular surfaces in patients with dry eye. Korean J Ophthalmol. 2007; 21:189–94.

23. Xu KP, Yagi Y, Tsubota K. Decrease in corneal sensitivity and change in tear function in dry eye. Cornea. 1996; 15:235–9.

24. Hiroko BM. Cataract surgery in the presence of other ocular comorbidities. Steinert RF, editor. Cataract Surgery: Technique, Complication and Management. 2nd ed.Philadelphia: Saunders;2004. chap. 32.

25. Walker TD. Benzalkonium toxicity. Clin Experiment Ophthalmol. 2004; 32:657.

26. Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009; 23:65–73.

27. Donnenfeld ED, Solomon R, Roberts CW, et al. Cyclosporine 0.05% to improve visual outcomes after multifocal intraocular lens implantation. J Cataract Refract Surg. 2010; 36:1095–100.

Figure 1.

Changes in tear film breakup time, Schirmer's test, tear clearance rate and keratoepitheliopathy after cataract surgery in the non-dry eye groups. HA = hyaluronate; CsA = cyclosporine A.^* p < 0.05 compared with each group.

Figure 2.

Changes in tear film breakup time, Schirmer's test, tear clearance rate and keratoepitheliopathy after cataract surgery in the dry eye groups. HA = hyaluronate; CsA = cyclosporine A.^* p < 0.05 compared with each group.

Table 1.

Changes in the tear film and ocular surface parameters after cataract operation in patients without dry eye

		Baseline	1 week after treatment	1 month after treatment	2 months after treatment	3 months after treatment	6 months after treatment
Group 1	Tear film breakup time (sec)	10.19 ± 2.17	4.78 ± 1.27^*	7.24 ± 2.89^*	7.81 ± 2.93^*	9.81 ± 3.04	9.89 ± 2.58
	Schirmer's test (mm)	11.41 ± 1.98	5.24 ± 1.55^*	6.38 ± 3.52^*	7.86 ± 3.92^*	11.30 ± 3.97	11.86 ± 3.58
	Tear clearance rate ((Log2)^-1)	5.95 ± 1.18	3.97 ± 1.52^*	3.49 ± 0.73^*	3.54 ± 0.93^*	5.54 ± 1.45	5.73 ± 1.22
	Keratoepitheliopathy score	0.16 ± 0.37	4.78 ± 1.11^*	0.24 ± 0.43	0.24 ± 0.43	0.24 ± 0.43	0.27 ± 0.73
Group 2	Tear film breakup time (sec)	10.08 ± 1.55	5.14 ± 1.49^*	7.05 ± 2.26^*	9.86 ± 2.53	9.86 ± 2.69	10.14 ± 2.04
	Schirmer's test (mm)	10.76 ± 2.60	4.68 ± 1.83^*	6.70 ± 3.19^*	10.54 ± 3.07	10.32 ± 2.65	10.51 ± 2.55
	Tear clearance rate ((Log2)^-1)	5.97 ± 1.14	4.05 ± 1.45^*	3.51 ± 0.69^*	5.35 ± 1.42	5.65 ± 1.25	5.89 ± 1.43
	Keratoepitheliopathy score	0.24 ± 0.43	4.81 ± 1.73^*	0.19 ± 0.40	0.24 ± 0.43	0.41 ± 0.86	0.43 ± 0.87

^* p<0.05 compared with baseline.

Table 2.

Changes in the tear film and ocular surface parameters after cataract operation in patients with dry eye

		Baseline	1 week after treatment	1 month after treatment	2 months after treatment	3 months after treatment	6 months after treatment
Group 3	Tear film breakup time (sec)	4.16 ± 0.83	3.26 ± 1.15^*	3.11 ± 1.20^*	3.26 ± 0.99^*	3.95 ± 1.08	4.21 ± 0.92
	Schirmer's test (mm)	4.11 ± 0.88	2.89 ± 0.94^*	3.47 ± 0.90^*	3.37 ± 0.96^*	3.95 ± 0.97	4.21 ± 0.85
	Tear clearance rate ((Log2)^-1)	3.47 ± 0.70	2.42 ± 0.96^*	2.74 ± 1.10^*	2.63 ± 1.01^*	3.11 ± 0.81	3.16 ± 0.96
	Keratoepitheliopathy score	2.21 ± 1.36	5.95 ± 2.15^*	3.58 ± 1.61^*	2.58 ± 1.54	2.05 ± 1.31	1.95 ± 1.31
Group 4	Tear film breakup time (sec)	4.15 ± 0.88	3.05 ± 1.10^*	4.25 ± 0.79	4.15 ± 0.75	4.95 ± 1.73	7.75 ± 1.52^†
	Schirmer's test (mm)	4.20 ± 0.89	2.85 ± 0.81^*	4.05 ± 0.83	4.10 ± 0.85	4.15 ± 0.88	6.50 ± 2.01^†
	Tear clearance rate ((Log2)^-1)	3.45 ± 0.69	2.45 ± 0.89^*	3.25 ± 0.79	3.30 ± 0.66	3.40 ± 0.68	4.40 ± 1.93
	Keratoepitheliopathy score	2.35 ± 1.31	5.60 ± 1.79^*	3.20 ± 1.82	3.05 ± 1.54	1.80 ± 1.28	1.55 ± 1.15

^* p<0.05 compared with baseline

^† p<0.05 improvement compared with baseline.

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