Effects of Preservative-free 3% Diquafosol in Patients with Pre-existing Dry Eye Disease after Cataract Surgery: A Randomized Clinical Trial

Abstract

Dry eye disease (DED) after cataract surgery has become a critical concern, and various therapeutic options have been developed. Recently, preservative-free diquafosol ophthalmic solution has been introduced; however, its therapeutic effect on DED after cataract surgery has not been reported. We investigated the efficacy of preservative-free diquafosol in patients with pre-existing DED after cataract surgery. We divided subjects who were diagnosed with DED and scheduled to undergo cataract surgery, into 3 groups (preservative-free diquafosol, group 1; preservative-containing diquafosol, group 2; preservative-free hyaluronate, group 3), and each eye drops was administered 6 times daily after surgery. Tear break up time (TBUT), Ocular Surface Disease Index (OSDI), corneal staining score, lid margin abnormality, and meibum quality improved over time in group 1. Groups 1 and 2 had significantly superior TBUT, meibomian gland dysfunction grade, and meibomian gland expressibility throughout the study period than group 3. Meibum quality of group 1 was significantly better than group 2 at 1 and 3 months after surgery. Preservative-free diquafosol showed better efficacy in treating DED after cataract surgery than preservative-containing diquafosol or preservative-free hyaluronate. Preservative-free diquafosol may serve as a reliable option for the management of patients with pre-existing DED after phacoemulsification.

Cataract surgery and dry eye disease: A review

“…Similar findings showing the superiority of Diquafosal in the management of post-operative DED compared to artificial tears have been documented in other RCTs. 115 – 117 The results of a recent meta-analysis of these RCTS by Zhao et al. 118 suggested that topical diquafosal 3% is more effective than artificial tears in the post-operative management of DED.…”

“…Similar findings showing the superiority of Diquafosal in the management of post-operative DED compared to artificial tears have been documented in other RCTs. [115][116][117] The results of a recent meta-analysis of these RCTS by Zhao et al 118 suggested that topical diquafosal 3% is more effective than artificial tears in the post-operative management of DED. At present this medication is not available in Europe but given its actions in reducing conjunctival goblet cell loss, which is known to occur after cataract surgery, 6,51 hopefully its introduction will help in the management of cataract surgery associated DED.…”

Efficacy and Safety of Sodium Hyaluronate/chondroitin Sulfate Preservative-free Ophthalmic Solution in the Treatment of Dry Eye: A Clinical Trial

“…However, we hypothesize that preservative-free lubricants may be safer than eye drops with preservatives in patients with DED. [26][27][28] All AEs were resolved by the end of the study period and no safety issues were raised.…”

A randomised, prospective study of the effects of 3% diquafosol on ocular surface following cataract surgery

“…Park et al concluded that the postoperative use of 3% DQS could significantly improve TBUT, corneal fluorescein stain score, and conjunctival lissamine stain score as compared to HA 22 . Although some other studies have examined the effect of DQS on DES after cataract surgery 15 , 17 , 19 , 23 , the included subjects had already had DES. The present study recruited patients with no ocular surface diseases, including DES, and revealed that the treatment of healthy eyes with 3% DQS could also effectively improve TBUT after cataract operation.…”