Immunomodulators an option for prepping patients with dry eye before cataract surgery



Hovanesian J, et al. Immunomodulators for acute preparation of the ocular surface for cataract surgery. Presented at: Hawaiian Eye; May 8-14, 2021; Wailea, Hawaii.

Hovanesian reports he is a consultant for, does contracted research for and has ownership interest in Novartis.

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WAILEA, Hawaii — Lifitegrast and cyclosporine are not only useful for long-term management of dry eye disease but are also effective in pre-cataract surgery patients with dry eye, according to a speaker at Hawaiian Eye 2021.

John A. Hovanesian

“Immunomodulators are not just for patients to take forever when they have dry eye,” John A. Hovanesian, MD, FACS, said. “They actually are very useful in the short term.”

Hovanesian and colleagues conducted two similar studies to measure biometry in patients with “significant” dry eye who were preparing to undergo cataract surgery before and after 4 weeks of treatment.

One study investigated lifitegrast ophthalmic solution 5% (Novartis) twice daily; the second studied cyclosporine ophthalmic solution 0.09% (Sun Pharmaceutical) twice daily. Although similar, the studies were not head-to-head comparisons.

Patients with corneal staining and tear breakup time less than 10 seconds underwent examinations before and after treatment with cyclosporine or lifitegrast to measure corneal staining, tear breakup time, redness, root mean square higher order aberrations and Standard Patient Evaluation of Eye Disease scores, Hovanesian said. Following surgery, researchers measured patients’ refractive outcomes.

Biometry performed after treatment with the immunomodulators (lifitegrast P < .04; cyclosporine P < .03) predicted refractive outcomes significantly more accurately than biometry performed pre-treatment, Hovanesian said.

In 77 patients treated with lifitegrast, 56% experienced a positive change in higher order aberrations (P < .001). In 64 patients treated with cyclosporine, 44% saw a positive change in higher order aberrations (P < .02).

Lifitegrast and cyclosporine .09% both significantly reduced dry eye symptoms. Additionally, the immunomodulators significantly reduced corneal staining and redness and improved tear breakup time, Hovanesian said.

“Across all parameters that all investigators studied, we saw significant improvement with these medications,” Hovanesian said. “And patients, now that they’re used to them through this treatment, can take them for life because they know what the drug is all about and they’re very happy to do so because they know it’s going to keep their vision as clear as it was after you performed your excellent surgery.”


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