Diquafosol for Dry Eye Disease Before and After Cataract Surgery, Preliminary Results: The Indonesian Research on Survey and Treatment for Dry Eye Disease (ThIRST DED)

Abstract

Purpose : Cataract surgery has been shown to exacerbate the signs and symptoms of pre-existing dry eye disease (DED). This single-masked, randomized controlled trial study determined the DED state and compared the therapeutic effects between diquafosol sodium 3% (DS) and sodium hyaluronate 0.1% (SH) eye drops in patients pre and post-routine cataract surgery.

Methods : Patients with cataracts at Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia, were initially classified by DED severity based on their Ocular Surface Disease Index (OSDI). Other objective parameters such as tear break-up time (TBUT), tear osmolarity, fluorescein break-up pattern, corneal sensibility, and the Schirmer test were evaluated. Patients were randomized to receive either DS or SH eye drops 4 times daily for 4 weeks, up to 21 days post cataract surgery. The treatments were then stopped and patients were followed up to day 90. The parameters were reassessed at 4 weeks pre-surgery (2nd examination), 21 days after surgery (3rd), and 90 days after surgery without treatment (4th).

Results : Seventy eyes were included, the mean±standard deviation (SD) age of participants was 54.11±13.30 years and 57.1% were female. The median OSDI score (range) at baseline was 40 (15–72). Most patients with DED experienced moderate symptoms (36/70; 51.4%), 19 (27.1%) were mild, and 15 (21.4%) severe. In total, 24 eyes were assessed in the preliminary study, with similar baseline characteristics in both groups. The DS group showed a statistically significant improvement in OSDI score (Δ mean±SD) compared with the SH group at the 2nd (DS vs SH; 12.92±9.86 vs 0.83±11.07) and 4th (33.08±15.15 vs 18.42±15.23, respectively) examinations (P<0.005). The TBUT value and tear osmolarity changes were improved in the DS group at the 2nd (4.10±3.54 vs; 5.92±10.35 mOsm/L) and 3rd (2.00[-9.00-5.00]) vs; 2.67±14.02 mOsm/L) examination with no significant difference versus the SH group. No significant differences were noted between groups in the Schirmer test and corneal sensibility in all examinations.

Conclusions : Most cataract patients have moderate degrees of DED at the initial visit. Through objective parameter changes, our preliminary study showed that DS exhibits immediate improvement of dry eye symptoms, and these improvements were maintained through objective parameter changes compared with SH.

This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.