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Abstract
Purpose
To evaluate the effectiveness of topically administered 0.05% cyclosporine combined with a topical steroid in the early postoperative period after cataract surgery, and to compare the therapeutic efficacy according to the severity of dry eye.
Methods
One hundred and fifty-six patients who underwent unilateral cataract surgery and received topical cyclosporine 0.05% for 8 weeks combined with a fluorometholone 0.1% steroid for 4-weeks were classified into three groups according to preoperative dry eye level: the control group, non-dry eye (n = 78); group 1, level I dry eye (n = 38); and group 2, level II dry eye (n = 40). The best-corrected distance visual acuity, intraocular pressure, dry eye symptom questionnaire (ocular surface disease index), tear film break-up time (TBUT), and Schirmer test-I (STI) were evaluated.
Results
The preoperative score of dry eye symptoms improved significantly at one week postoperatively and continued to improve until postoperative 8-weeks in all groups, especially in group 2 compared with the control. Groups 1 and 2 showed significant improvement in the TBUT at one week, four weeks, and eight weeks postoperatively, compared to eight weeks postoperatively in the control; Group 2, especially, showed significant improvement in TBUT. There was no difference in STI value after cyclosporine-steroid treatment in the control group; however, a significant difference was observed at four weeks postoperatively in dry eyes. No significant differences in STI results were observed among the three groups.
Figures and Tables
Figure 1
Schematic flow chart of this study. The BCDVA, IOP, STI, TBUT, and OSDI questionnaire were performed or administered at 1-week, 4-weeks, and 8-weeks postoperatively. BCDVA = best corrected distant visual acuity; IOP = intraocular pressure; STI = Schirmer test I; TBUT = tear film break-up time; OSDI = ocular surface disease index score.
Figure 2
Changes of ocular surface disease index (OSDI) score after cataract surgery. The OSDI score improved significantly at postoperative 1-week and continuously improved until postoperative 8-weeks in all three groups. W = weeks; m = months. *Significant improvement (one-way analysis of variance, p < 0.05) compared with preoperative values.
Figure 3
Changes of tear film break-up time (TBUT) after cataract surgery. In the control group, the TBUT improved significantly at postoperative 8-weeks. The Group 1 showed significant improvement in the TBUT at 1-week, 4-weeks, and 8-weeks postoperatively. In the Group 2, the TBUT also improved significantly at 1-week, 4-weeks, and 8-weeks postoperatively. W = weeks; m = months. *Significant improvement (one-way analysis of variance, p < 0.05) compared with preoperative values.
Figure 4
Changes of Schirmer test I (STI) after cataract surgery. In the Group 1 and Group 2, the STI improved significantly at postoperative 4-weeks. W = weeks; m = months. *Significant improvement (one-way analysis of variance, p < 0.05) compared with preoperative values.
Figure 5
The magnitude of changes in the preoperative dry eye after cataract surgery compared among all the three groups. The OSDI score improvement of group 2 was significantly larger than that of control group at postoperative 8-weeks. The tear film break-up time (TBUT) improvement was significantly larger in group 1 and group 2, compared to control group at postoperative 1-week. There was significant difference in TBUT improvement only between the group 2 and the control group at postoperative 4- and 8-weeks. OSDI = ocular surface disease index; W = weeks; STI = Schirmer test I. *Significant difference (p < 0.05) among the three groups.
Table 1
The baseline characteristics of each group
Data were compared between each individual treatment group and the control group at 1 week and 1 and 2 months. One-way analysis of variance was used to compare between each group. Significance was indicated at p < 0.05. Values are presented as mean ± standard deviation unless otherwise indicated.
M:F = male:female; BCDVA = the best corrected distant visual acuity; logMAR = the logarithm of minimal angle of resolution; IOP = intraocular pressure; TBUT = tear film break-up time; OSDI = ocular surface disease index score.
Notes
References
1. Khanal S, Tomlinson A, Esakowitz L, et al. Changes in corneal sensitivity and tear physiology after phacoemulsification. Ophthalmic Physiol Opt. 2008; 28:127–134.
2. Kohlhaas M. Corneal sensation after cataract and refractive surgery. J Cataract Refract Surg. 1998; 24:1399–1409.
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–S20.
4. 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; 36:1095–1100.
5. Chung YW, Oh TH, Chung SK. The effect of topical cyclosporine 0.05% on dry eye after cataract surgery. Korean J Ophthalmol. 2013; 27:167–171.
6. Sahli E, Hoşal BM, Zilelioğlu G, et al. The effect of topical cyclosporine A on clinical findings and cytological grade of the disease in patients with dry eye. Cornea. 2010; 29:1412–1416.
7. Baiza-Durán L, Medrano-Palafox J, Hernández-Quintela E, et al. A comparative clinical trial of the efficacy of two different aqueous solutions of cyclosporine for the treatment of moderate-to-severe dry eye syndrome. Br J Ophthalmol. 2010; 94:1312–1315.
8. Report of the Definition and Classification Subcommittee of the International Dry Eye WorkShop. The definition and classification of dry eye disease. Ocul Surf. 2007; 5:75–92.
9. Schiffman RM, Christianson MD, Jacobsen G, et al. Reliability and validity of the Ocular Surface Disease Index. Arch Ophthalmol. 2000; 118:615–621.
10. Lemp MA. Report of the National Eye Institute/Industry workshop on Clinical Trials in Dry Eyes. CLAO J. 1995; 21:221–232.
11. Kasetsuwan N, Satitpitakul V, Changul T, Jariyakosol S. Incidence and pattern of dry eye after cataract surgery. PLoS one. 2013; 8:e78657.
12. Liu Z, Luo L, Zhang Z, et al. Tear film changes after phacoemulsification. Zhonghua Yan Ke Za Zhi. 2002; 38:274–277.
13. Cho YK, Kim MS. Dry eye after cataract surgery and associated intraoperative risk factors. Korean J Ophthalmol. 2009; 23:65–73.
14. Müller LJ, Vrensen GF, Pels L, et al. Architecture of human corneal nerves. Invest Ophthalmol Vis Sci. 1997; 38:985–994.
15. Roberts CW, Elie ER. Dry eye symptoms following cataract surgery. Insight. 2007; 32:14–21.
16. Wilson WS, Duncan AJ, Jay JL. Effect of benzalkonium chloride on the stability of the precorneal tear film in rabbit and man. Br J Ophthalmol. 1975; 59:667–669.
17. Zabel RW, Mintsioulis G, MacDonald IM, et al. Corneal toxic changes after cataract extraction. Can J Ophthalmol. 1989; 24:311–316.
18. Al-Aqaba MA, Fares U, Suleman H, et al. Architecture and distribution of human corneal nerves. Br J Ophthalmol. 2010; 94:784–789.
19. Hamada S, Moore TCB, Moore JE, et al. Assessment of the effect of cyclosporine A 0.05% emulsion on the ocular surface and corneal sensation following cataract surgery. Cont Lens Anterior Eye. 2016; 39:15–19.
20. Choi W, Yoon KC. Effect of 0.1% sodium hyaluronate and 0.05% cyclosporine on tear film parameters after cataract surgery. J Korean Ophthalmol Soc. 2011; 52:800–806.
21. Peyman GA, Sanders DR, Batlle JF, et al. Cyclosporine 0.05% ophthalmic preparation to aid recovery from loss of corneal sensitivity after LASIK. J Refract Surg. 2008; 24:337–343.
22. Sall K, Stevenson OD, Mundorf TK, Reis BL. Two multicenter, randomized studies of the efficacy and safety of cyclosporine ophthalmic emulsion in moderate to severe dry eye disease. CsA Phase 3 Study Group. Ophthalmology. 2000; 107:631–639.
23. Lee HS, Jang JY, Lee SH, et al. Clinical effectiveness of topical cyclosporine a 0.05% after laser epithelial keratomileusis. Cornea. 2013; 32:e150–e155.
24. Ursea R, Purcell TL, Tan BU, et al. The effect of cyclosporine A (Restasis) on recovery of visual acuity following LASIK. J Refract Surg. 2008; 24:473–476.
25. Sheppard JD, Scoper SV, Samudre S. Topical loteprednol pretreatment reduces cyclosporine stinging in chronic dry eye disease. J Ocul Pharmacol Ther. 2011; 27:23–27.
26. Cho P, Yap M. Schirmer test. II. A clinical study of its repeatability. Optom Vis Sci. 1993; 70:157–159.
27. Massingale ML, Li X, Vallabhajosyula M, et al. Analysis of inflammatory cytokines in the tears of dry eye patients. Cornea. 2009; 28:1023–1027.
28. Byun YJ, Kim TI, Kwon SM, et al. Efficacy of combined 0.05% cyclosporine and 1% methylprednisolone treatment for chronic dry eye. Cornea. 2012; 31:509–513.
29. Toker E, Asfuroğlu E. Corneal and conjunctival sensitivity in patients with dry eye: the effect of topical cyclosporine therapy. Cornea. 2010; 29:133–140.
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