J Korean Ophthalmol Soc.  2014 Dec;55(12):1752-1757. 10.3341/jkos.2014.55.12.1752.

Efficacy of Topical Cyclosporine in Mild Dry Eye Patients Having Refractive Surgery

• Kang KW
• Kim HK

• KMID: 2338956
• DOI: http://doi.org/10.3341/jkos.2014.55.12.1752

Abstract

PURPOSE
To evaluate the efficacy of pre- and post-operative use of topical 0.05% cyclosporine A (CsA) in mild dry eye patients having refractive surgery.
METHODS
This randomized prospective study included 40 patients with mild dry eye syndrome who were scheduled for laser in situ keratomileusis (LASIK). All patients were divided into 2 groups. Patients in the CsA group used both 0.1% sodium hyaluronate (HA) and 0.05% CsA from 2 weeks before to 8 weeks after the surgery, while patients in the control group used 0.1% HA only. Ocular surface disease index (OSDI), tear film break-up time (TF-BUT), Oxford Stain Score (OSS), and tear osmolarity were evaluated before surgery and 1, 4, and 8 weeks after surgery.
RESULTS
TF-BUT was significantly longer in the CsA group at 1 and 4 weeks post-operatively (p = 0.024, p = 0.036) compared to the control group. Tear osmolarity was significantly lower in the CsA group at 1 week post-operatively (p = 0.004) compared to the control group.
CONCLUSIONS
The pre- and post-operative use of topical 0.05% CsA is effective in alleviating dry eye symptom after LASIK in patients with dry eye syndrome.

Keyword

Cyclosporine; Dry eye syndrome; LASIK; Refractive surgery

MeSH Terms

Cyclosporine*
Dry Eye Syndromes
Humans
Hyaluronic Acid
Keratomileusis, Laser In Situ
Osmolar Concentration
Prospective Studies
Refractive Surgical Procedures*
Tears
Cyclosporine
Hyaluronic Acid

Figure

• 

  Figure 1. Changes in ocular surface disease index (OSDI), tear film break-up time (TF-BUT), Oxford stain score (OSS), and tear osmolarity after laser in situ keratomileusis (LASIK). Preop = preoperative; POD = postoperative day.

Reference

References

1. Pflugfelder SC, Tseng SC, Sanabria O, et al. Evaluation of subjective assessments and objective diagnostic tests for diagnosing tear-film disorders known to cause ocular irritation. Cornea. 1998; 17:38–56.

2. Dursun D, Kim MC, Solomon A, Pflugfelder SC. Treatment of recalcitrant recurrent corneal erosions with inhibitors of matrix met-alloproteinase-9, doxycycline and corticosteroids. Am J Ophthalmol. 2001; 132:8–13.

3. Marsh P, Pflugfelder SC. Topical nonpreserved methylprednisolone therapy for keratoconjunctivitis sicca in Sjögren syndrome. Ophthalmology. 1999; 106:811–6.

4. Gündüz K, Ozdemir O. Topical cyclosporin treatment of keratoconjunctivitis sicca in secondary Sjögren's syndrome. Acta Ophthalmol (Copenh). 1994; 72:438–42.

5. Tsubota K, Goto E, Fujita H, et al. Treatment of dry eye by autologous serum application in Sjögren's syndrome. Br J Ophthalmol. 1999; 83:390–5.

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

7. Stern ME, Beuerman RW, Fox RI, et al. The pathology of dry eye: the interaction between the ocular surface and lacrimal glands. Cornea. 1998; 17:584–9.

8. Stern ME, Gao J, Siemasko KF, et al. The role of the lacrimal functional unit in the pathophysiology of dry eye. Exp Eye Res. 2004; 78:409–16.

9. Smith VA, Rishmawi H, Hussein H, Easty DL. Tear film MMP accumulation and corneal disease. Br J Ophthalmol. 2001; 85:147–53.

10. Solomon A, Dursun D, Liu Z, et al. Pro- and anti-inflammatory forms of interleukin-1 in the tear fluid and conjunctiva of patients with dry-eye disease. Invest Ophthalmol Vis Sci. 2001; 42:2283–92.

11. Argüeso P, Balaram M, Spurr-Michaud S, et al. Decreased levels of the goblet cell mucin MUC5AC in tears of patients with Sjögren syndrome. Invest Ophthalmol Vis Sci. 2002; 43:1004–11.

12. Kunert KS, Tisdale AS, Gipson IK. Goblet cell numbers and epithelial proliferation in the conjunctiva of patients with dry eye syndrome treated with cyclosporine. Arch Ophthalmol. 2002; 120:330–7.

13. 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; 107:631–9.

14. 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.

15. Brignole F, Pisella PJ, De Saint Jean M, et al. Flow cytometric analysis of inflammatory markers in KCS: 6-month treatment with topical cyclosporin A. Invest Ophthalmol Vis Sci. 2001; 42:90–5.

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. 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.

18. Aras C, Ozdamar A, Bahcecioglu H, et al. Decreased tear secretion after laser in situ keratomileusis for high myopia. J Refract Surg. 2000; 16:362–4.

19. Jabbur NS, Sakatani K, O'Brien TP. Survey of complications and recommendations for management in dissatisfied patients seeking a consultation after refractive surgery. J Cataract Refract Surg. 2004; 30:1867–74.

20. Toda I, Asano-Kato N, Komai-Hori Y, Tsubota K. Dry eye after laser in situ keratomileusis. Am J Ophthalmol. 2001; 132:1–7.

21. 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.

22. Adenis JP, Bernard JA, Ducasse A, et al. [Dry syndrome and cataract surgery A case]. J Fr Ophtalmol. 1996; 19:222–4.

23. Golubovic S, Parunovic A. Corneal perforation in dry eye patients. Fortschr Ophthalmol. 1987; 84:33–7.

24. Mehra KS, Elaraoud MS. Total central keratolysis. Ann Ophthalmol. 1992; 24:54–5.

25. Albietz JM, Lenton LM, McLennan SG. Effect of laser in situ keratomileusis for hyperopia on tear film and ocular surface. J Refract Surg. 2002; 18:113–23.

26. Toda I, Asano-Kato N, Hori-Komai Y, Tsubota K. Laser-assisted in situ keratomileusis for patients with dry eye. Arch Ophthalmol. 2002; 120:1024–8.

27. Quiros PA, Chuck RS, Smith RE, et al. Infectious ulcerative keratitis after laser in situ keratomileusis. Arch Ophthalmol. 1999; 117:1423–7.

28. Patel S, Pérez-Santonja JJ, Alió JL, Murphy PJ. Corneal sensitivity and some properties of the tear film after laser in situ keratomileusis. J Refract Surg. 2001; 17:17–24.

29. Wilson SE. Laser in situ keratomileusis-induced (presumed) neurotrophic epitheliopathy. Ophthalmology. 2001; 108:1082–7.

30. Peyman GA, Sand, ers DR, Batlle JF, et al. Cyclosporine 0.05% ophthalmic preparation to aid recovery from loss of corneal sensitivity after LASIK. J Refract Surg. 2008; 24:337–43.

31. Toker E, Asfuroğlu E. Corneal and conjunctival sensitivity in patients with dry eye: the effect of topical cyclosporine therapy. Cornea. 2010; 29:133–40.

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

33. Liu H, Begley C, Chen M, et al. A link between tear instability and hyperosmolarity in dry eye. Invest Ophthalmol Vis Sci. 2009; 50:3671–9.

34. Vanley GT, Leopold IH, Gregg TH. Interpretation of tear film breakup. Arch Ophthalmol. 1977; 95:445–8.

35. Nichols KK, Mitchell GL, Zadnik K. The repeatability of clinical measurements of dry eye. Cornea. 2004; 23:272–85.

36. Heigle TJ, Pflugfelder SC. Aqueous tear production in patients with neurotrophic keratitis. Cornea. 1996; 15:135–8.

37. Müller LJ, Marfurt CF, Kruse F, Tervo TM. Corneal nerves: structure, contents and function. Exp Eye Res. 2003; 76:521–42.

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

39. 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; 52:800–6.

40. Donnenfeld ED, Ehrenhaus M, Solomon R, et al. Effect of hinge width on corneal sensation and dry eye after laser in situ keratomileusis. J Cataract Refract Surg. 2004; 30:790–7.

41. Mian SI, Shtein RM, Nelson A, Musch DC. Effect of hinge position on corneal sensation and dry eye after laser in situ keratomileusis using a femtosecond laser. J Cataract Refract Surg. 2007; 33:1190–4.

42. Nettune GR, Pflugfelder SC. Post-LASIK tear dysfunction and dysesthesia. Ocul Surf. 2010; 8:135–45.

43. Bragheeth MA, Dua HS. Corneal sensation after myopic and hyperopic LASIK: clinical and confocal microscopic study. Br J Ophthalmol. 2005; 89:580–5.

44. Mian SI, Li AY, Dutta S, et al. Dry eyes and corneal sensation after laser in situ keratomileusis with femtosecond laser flap creation Effect of hinge position, hinge angle, and flap thickness. J Cataract Refract Surg. 2009; 35:2092–8.