Prophylactic cyclosporine eye drops reduce ocular inflammation after cataract surgery, reveals study

A recent study published in the recent issue of Cornea journal highlighted the significant rates of dissatisfaction following cataract surgery that pointed ocular surface discomfort as a primary cause. The study indicated that 20% to 35% of patients experienced dissatisfaction post-surgery due to this issue. This study investigated the role of age-related parainflammation in this discomfort and explored preventive measures through immune-modulating prophylactic management.

The prospective, randomized, open-label and unmasked clinical trial included a total of 100 patients who were diagnosed with cataracts. These patients underwent phacoemulsification surgery which is a common procedure to treat cataracts. The participants were divided into four groups of 25 patients; the patients in Group A had patients under 65 years old who received surgery only, the Group B included patients over 75 years old who received surgery only, the Group C had patients over 75 years old who used cyclosporine A 0.1% cationic emulsion (CE) eye drops twice daily for 30 days before surgery and in the Group D were the patients over 75 years old who used CE lubricating eye drops twice daily for 30 days before surgery. The patients were monitored for 90 days following surgery, with the primary outcome being postoperative ocular surface failure and the secondary outcome included the impact of prophylactic cyclosporine A 0.1% CE therapy on the ocular surface.

The study revealed that patients in Group B underwent the most severe ocular surface signs and symptoms throughout the study period when compared to other groups. Also, the younger cohort of Group A expressed milder signs and symptoms. Significant improvements were observed in Group C, which used the prophylactic cyclosporine A 0.1% CE eye drops. This group showed reduced conjunctival symptom assessment in dry eye values, decreased conjunctival hyperemia severity and less meibomian gland dysfunction by Day 45 when compared to the Group B. Also, Group C expressed an increased tear break-up time.

The study also found that ocular surface inflammatory markers, including HLADR, intercellular adhesion molecule 1 (ICAM-1), and interleukin 6 (IL-6), were significantly downregulated in Group C at 90 days compared to Group B. The findings highlight that cataract surgery can induce a persistent inflammatory state called as InflammAging in patients older than 75 years. The use of prophylactic cyclosporine A 0.1% CE eye drops significantly enhanced the ocular surface homeostasis and reduced inflammatory markers which is a promising strategy for managing and preventing ocular surface discomfort following cataract surgery in elderly patients.

Source:

Di Zazzo, A., Spelta, S., Micera, A., De Gregorio, C., Affatato, M., Esposito, G., Balzamino, B. O., Sgrulletta, R., Coassin, M., & Bonini, S. (2024). Prophylactic Therapy for Long-Term Ocular Discomfort After Cataract Surgery. In Cornea. Ovid Technologies (Wolters Kluwer Health). https://doi.org/10.1097/ico.0000000000003561