J Korean Ophthalmol Soc.  2019 Sep;60(9):821-828. 10.3341/jkos.2019.60.9.821.

Effectiveness of Cyclosporine-steroid Treatment after Cataract Surgery according to Dry Eye Severity

• Park JY
• Yang SC
• Park YM
• Lee JE
• Park CY
• Lee JS

• KMID: 2459125
• DOI: http://doi.org/10.3341/jkos.2019.60.9.821

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.
CONCLUSIONS
Use of topical cyclosporine 0.05% combined with a topical fluorometholone 0.1% steroid after cataract surgery is more effective in dry eyes level II than in non-dry eyes, especially those with TBUT and dry eye symptoms at eight weeks postoperatively.

Keyword

Cataract surgery; Cyclosporine; Dry eye syndrome

MeSH Terms

Cataract*
Cyclosporine
Dry Eye Syndromes
Fluorometholone
Humans
Intraocular Pressure
Postoperative Period
Sexually Transmitted Diseases
Tears
Visual Acuity
Cyclosporine
Fluorometholone

Figure

• 

  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.

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