Rebamipide Versus Diquafosol and Cyclosporine for Perioperative Dry Eye in Cataract Surgery

Dry eye disease (DED) is common in patients undergoing cataract surgery and may worsen during the perioperative period, leading to ocular discomfort and delayed visual recovery. Pharmacologic treatments targeting tear film instability and ocular surface inflammation are therefore important in perioperative management.

This prospective, randomized, parallel-group clinical trial compared two perioperative treatment strategies for DED in patients scheduled for cataract surgery. Eligible participants with pre-existing dry eye disease were randomized in a 1:1 ratio to receive either topical rebamipide 2% monotherapy or combination therapy with topical diquafosol 3% and cyclosporine 0.05%. Study medications were initiated 1 month prior to surgery and continued for 3 months postoperatively.

The primary outcome measure was the change in tear film breakup time (TBUT) during the early postoperative period. Secondary outcome measures included changes in corneal staining graded by the Oxford scale, patient-reported symptoms assessed by the Ocular Surface Disease Index (OSDI), tear secretion measured by Schirmer's test, and ocular surface inflammation evaluated using a tear matrix metalloproteinase-9 (MMP-9) point-of-care immunoassay.

Clinical assessments were performed at baseline, on the day of surgery, and at postoperative week 1, month 1, and month 3. Safety was evaluated by monitoring intraoperative and postoperative adverse events throughout the study period.

Inclusion criteria

• Adults scheduled for cataract surgery
• Presence of dry eye disease, defined as an Ocular Surface Disease Index (OSDI) score ≥12 and at least one of the following:

• Tear film breakup time (TBUT) ≤7 seconds
• Oxford corneal staining grade ≥1
• Schirmer's test value ≤10 mm/5 min
• Ability and willingness to comply with the study protocol and follow-up schedule
• Provision of written informed consent

Exclusion criteria

• Presence of ocular surface or ocular conditions that could affect dry eye status (e.g., active keratitis or ocular infection)
• Use of topical intraocular pressure-lowering medications
• History of ocular surgery other than cataract surgery in the study eye
• Any systemic or ocular condition judged by the investigator to interfere with study participation or outcome assessment