Cyclosporine A eye drops ease ocular discomfort after cataract surgery, study finds

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Ocular surface discomfort can be problematic after cataract surgery. Italian researchers tested the use of cyclosporine A 0.1% cationic emulsion eye drops to prophylactically minimize the discomfort before cataract surgery and found that their use improved ocular surface homeostasis and reduced inflammatory markers.¹

Cationic emulsion drops are characterized by their ability to retain cyclosporine A on the ocular surface.

Antonio DiZazzo, MD, and colleagues reported their findings in Cornea. He is associated with the Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, and the University Campus Bio-Medico, both in Rome.

They emphasized that the rates of patient dissatisfaction following cataract surgery can range from 20% to 35% as the result of age-related ocular surface discomfort, which this study investigated along with the ability of prophylactic treatment to manage it.

The conducted a prospective, randomized, open-label, unmasked clinical trial in one teaching hospital where 100 patients with cataracts underwent phacoemulsification. The patients were divided into four groups each comprised of 25 patients. Groups A (<65 years) and B (>75 years) underwent surgery only; groups C and D (both >75 years) were assigned to cyclosporine A 0.1% cationic emulsion eye drops or cationic emulsion lubricating eye drops (both twice daily), respectively, for 30 days preoperatively. Patients were followed for 90 days postoperatively.

The primary outcome was the failure of the postoperative ocular surface, and the secondary outcome was the effect of prophylactic cyclosporine A 0.1% cationic emulsion therapy on the ocular surface outcomes, the authors recounted.

Results of prophylaxis

The authors reported that the patients in group B had more severe ocular surface signs and symptoms during the study compared with the other three groups, and group A typically had lower signs and symptoms.

Regarding the groups treated prophylactically, the patients in group C showed significant reductions in conjunctival Symptom Assessment in Dry Eye values (P < 0.05), the severity of conjunctival hyperemia (P < 0.01), and meibomian gland dysfunction (P < 0.001) on day 45, compared with the patients in group B, and the tear break-up time increased (P < 0.001), Di Zazzo and colleagues reported.

Ocular surface inflammatory marker transcription (human leukocyte antigen-DR, intercellular adhesion molecule 1, and interleukin 6) was down-regulated significantly in group C compared with group B at 90 days (P < 0.05).

The authors concluded, “Cataract surgery induced ocular surface system failure with a clinically significant persistent inflammatory status (InflammAging defined as chronic low-grade inflammation associated with the aging process) in patients older than 75 years. Prophylactic cyclosporine A 0.1% CE eye drops were associated with improved ocular surface homeostasis and reductions in inflammatory markers.”

Reference:

1. Di Zazzo A, Spelta S, Micera A, et al.Prophylactic therapy for long-term ocular discomfort after cataract surgery. Cornea. 2025;44:443-449. doi: 10.1097/ICO.0000000000003561