Cyclosporine A Eases Post-Cataract Surgery Discomfort

A recent study conducted by Italian researchers highlights the benefits of cyclosporine A 0.1% cationic emulsion eye drops in improving ocular surface homeostasis and reducing inflammation when used prophylactically before cataract surgery.

Addressing Post-Cataract Surgery Ocular Discomfort

Ocular surface discomfort is a common postoperative complication following cataract surgery, affecting 20% to 35% of patients, particularly due to age-related ocular surface dysfunction. Researchers at the Ophthalmology Complex Operative Unit, Campus Bio-Medico Foundation, and the University Campus Bio-Medico in Rome, led by Antonio Di Zazzo, MD, explored whether preoperative prophylactic treatment with cyclosporine A 0.1% cationic emulsion eye drops could improve postoperative outcomes.

Cationic emulsion eye drops are specifically designed to enhance the retention of cyclosporine A on the ocular surface, thereby stabilizing the tear film and reducing inflammation.

Study Design and Patient Groups

The study was a prospective, randomized, open-label, unmasked clinical trial conducted at a teaching hospital, involving 100 cataract patients undergoing phacoemulsification. Participants were divided into four groups:

• Group A (<65 years old): Underwent cataract surgery only.

• Group B (>75 years old): Underwent cataract surgery only.

• Group C (>75 years old): Received cyclosporine A 0.1% cationic emulsion eye drops twice daily for 30 days preoperatively.

• Group D (>75 years old): Received cationic emulsion lubricating eye drops twice daily for 30 days preoperatively.

Patients were monitored for 90 days postoperatively, with the primary outcome being postoperative ocular surface failure and the secondary outcome assessing the effect of prophylactic cyclosporine A treatment on ocular surface health.

Key Findings: The Impact of Cyclosporine A Prophylaxis

Patients in Group B (>75 years, no prophylaxis) exhibited more severe ocular surface symptoms compared to all other groups, while Group A (<65 years, no prophylaxis) had the lowest signs of ocular discomfort.

Patients in Group C (cyclosporine A prophylaxis) demonstrated significant improvements in several ocular surface parameters, compared to Group B:

• Reduced conjunctival symptoms (Symptom Assessment in Dry Eye values, P < 0.05)

• Lower severity of conjunctival hyperemia (P < 0.01)

• Improved meibomian gland function (P < 0.001)

• Increased tear break-up time (TBUT) (P < 0.001)

Additionally, ocular surface inflammatory markers—including human leukocyte antigen-DR, intercellular adhesion molecule 1, and interleukin 6—were significantly downregulated in Group C at 90 days (P < 0.05), indicating a reduction in chronic inflammation.

Conclusion: The Role of Cyclosporine A in Ocular Surface Protection

The study findings confirm that cataract surgery induces ocular surface dysfunction, particularly in patients older than 75 years, leading to a persistent low-grade inflammatory state (InflammAging). However, preoperative prophylactic treatment with cyclosporine A 0.1% cationic emulsion eye drops was associated with:

• Enhanced ocular surface homeostasis

• Reduced postoperative inflammation

• Better patient comfort and fewer symptoms of ocular surface disease

These results suggest that cyclosporine A prophylaxis may be a valuable approach to improving post-cataract surgery outcomes, particularly in older patients who are at higher risk for ocular surface complications.

Reference:

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