Assessment of the effect of cyclosporine-A 0.05% emulsion on the ocular surface and corneal sensation following cataract surgery Samer Hamada a,b,c , Tara C.B. Moore a , Jonathan E. Moore a,d , Madonna G. Al-Dreihi e , Anas Anbari c,e , Sunil Shah a,b,f, * a School of Biomedical Sciences, University of Ulster, Coleraine, NI, UK b Birmingham and Midland Eye Centre, Birmingham, UK c Corneo Plastic Unit and Eye Bank, Queen Victoria Hospital, East Grinstead, UK d Cathedral Eye Clinic, Belfast, NI, UK e Manar International Hospital, Damascus, Syria f Midland Eye, Solihull, UK A R T I C L E I N F O Article history: Received 2 December 2014 Received in revised form 13 July 2015 Accepted 14 July 2015 Keywords: Cyclosporine-A Corneal sensation Cataract surgery Ocular surface Corneal nerves recovery Anti-inflammatory A B S T R A C T Aim: To assess the effect of cyclosporine-A (CsA) 0.05% ophthalmic emulsion on corneal sensation and ocular surface problems following cataract surgery. Design: Prospective, randomized, double masked clinical trial. Methods: Consecutive case series of patients attending for bilateral cataract surgery. Subject’s eyes were randomized to receive either topical CsA or carboxymethylcellulose 0.5% (CMC) eye drops twice daily for one month following routine cataract surgery. Subjective and objective assessments were performed pre-operatively, one week, and one month after surgery. Primary safety parameters included best spectacle-corrected visual acuity and incidence of adverse events. Objective assessments included tests of tear film (osmolarity, tear break-up time, and Schirmer’s type-I test), ocular surface staining, corneal sensitivity and a subjective assessment: ocular surface disease index (OSDI) questionnaire. Results: 30 subjects (60 eyes) were recruited. At one month following cataract surgery, osmolarity, ocular surface staining, TBUT, Schirmer’s results showed a greater improvement after CsA drops compared to CMC and this was statistically significant for all measures (p < 0.05). All corneal sensation measurements were reduced after one week and one month. Eyes receiving CsA had higher recovery of corneal sensation at both time points post operatively and this was statistically significant at one month. OSDI questionnaire results did not show a statistically significant difference between the two eyes. Conclusions: CsA is effective and safe in the management of ocular surface problems after cataract surgery and allows faster recovery of corneal sensation. This recovery of sensation may be relevant to the improvement in ocular surface problems in all patients. ã 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. 1. Introduction Recent advances in ophthalmology, in particular those relating to cataract surgery have led to an increasing focus on the qualitative outcomes of cataract surgery. Measurement of patient’s satisfaction after cataract surgery now includes not only the visual outcomes but also ocular comfort and the patient’s experience of surgery [1]. The occurrence of dry eye in the first few months following cataract surgery has been frequently reported [2,3]. Several factors could exacerbate a dry eye condition or lead to a new transient status of dry eye in patients following cataract surgery including disruption of corneal nerves [4], ocular surface toxicity from topical ophthalmic medications [5,6], and the surgical procedure itself [7]. Khanal et al. described a deterioration in corneal sensitivity and tear physiology immediately after small incision cataract surgery, which does not return to preoperative levels until three months postoperatively, whereas the tear function recovers within one month [3]. Lyne has also demonstrated anaesthesia in the upper half of the cornea even after one year [8]. Suboptimal visual outcomes in the period immediately after cataract surgery (particularly with premium intraocular lenses) are * Corresponding author at: Midland Eye, 50 Lode Lane, Solihull, West Midlands B91 2AW, UK. E-mail address: sunilshah@doctors.net.uk (S. Shah). http://dx.doi.org/10.1016/j.clae.2015.07.003 1367-0484/ ã 2015 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved. Contact Lens and Anterior Eye 39 (2016) 15–19 Contents lists available at ScienceDirect Contact Lens and Anterior Eye journal homepage: www.else vie r.com/locat e/clae