Effects of 3% diquafosol sodium ophthalmic solution on higher-order aberrations in patients diagnosed with dry eye after cataract surgery

Abstract

PurposeTo evaluate the effects of diquafosol sodium ophthalmic solution 3% (DQS) and artificial tears (AT) on higher-order aberrations (HOAs) in patients with dry eye after cataract surgery.DesignThis was a post hoc analysis of a previously conducted randomized clinical study.MethodsFifty-nine eyes from 42 patients (17 males and 25 females, aged 72.6±8.0 years) with verified or suspected dry eye at 4 weeks after cataract surgery were evaluated. The dry eye patients were randomly assigned to receive DQS or AT for 4 weeks. Tear breakup time (BUT), corneal and conjunctival fluorescein staining scores, and HOAs were analyzed before and after instillation. HOAs were measured consecutively for 10 seconds with a wavefront analyzer. Average HOAs, HOA fluctuations (fluctuation index [FI]) and changes in HOAs (stability index [SI]) were compared within and between the two groups.ResultsAfter 4 weeks of instillation, BUT significantly increased (P=0.001) compared with preinstillation values in the DQS group, but not in the AT group. This increase in BUT in the DQS group was significantly greater than in the AT group (P=0.014). Corneal and conjunctival fluorescein staining scores after instillation significantly improved compared with preinstillation values in the DQS group (P=0.018). In HOAs, the cornea aberration changed from an upward curve (a sawtooth pattern) to an almost constant value (a stable pattern) in the DQS group, but not in the AT group. In FI and SI, there were no significant changes in either group; however, FI and SI were significantly lower in the DQS group than in the AT group (both, P=0.004).ConclusionThe dry eye patients after cataract surgery had a visual dysfunction in HOAs. DQS is effective to treat dry eye disease after cataract surgery with improvement of visual function.

Comparison of the efficacy between topical diquafosol and artificial tears in the treatment of dry eye following cataract surgery

“…Together, 3 studies [ 15 , 20 , 21 ] included 133 eyes in the DQS group and 144 eyes in the AT group described the BUT before the treatment of postoperative dry eye. When pooling the data of pretherapeutic BUT, fixed-effect models were used as Chi-squared test manifested no heterogeneity.…”

“…Four papers [ 15 , 20 – 22 ] described the post-therapeutic BUT, including 178 eyes in DQS group and 193 patients in AT group. Sensitivity analysis and subgroup analysis failed to eliminate the detected heterogeneity ( P = .056, I 2 = 60.3%).…”

“…[ 4 , 13 , 14 ] According to the Japanese criteria of dry eye, the prevalence of postoperative dry eye was reported to be as high as 55.7%, this acute and iatrogenic disorder urgently required appropriate clinical management. [ 4 , 13 – 15 ]…”

“…However, the effect of DQS on dry eye after cataract surgery was scarcely studied and relatively unclear, the sample sizes of previous studies were relatively small and may not detect the difference as statistically significant. [ 15 , 20 – 22 ] In addition, some studies suggested that the addition of DQS or AT may equally relieve dry eye after cataract surgery. [ 22 ] As DQS is significantly more expensive than common AT, we need more solid evidence to conclude whether the application of DQS in our routine regimen of postoperative therapy for dry eye following cataract surgery is appropriate.…”

Effects of tear film dynamics on quality of vision

“…A previous investigation, using sequential wavefront measurements, revealed that diquafosol was effective for treating dry eye after cataract surgery, with prolonged BUT and improved optical quality. An upward pattern in HOAs after the blink observed before the cataract surgery shifted to a stable pattern after the 4-week treatment with diquafosol 56. Rebamipide was effective for improvement of optical quality and BUT in cases of short BUT-type dry eye 57…”