Efficacy of topical cyclosporine A in optimizing ocular surface and relieving dry eye symptoms after cataract surgery: a systematic review and meta-analysis of randomized controlled trials

Purpose Dry eye symptoms and signs are common following cataract surgery. Topical cyclosporine A (CsA) is an approved treatment of moderate-to-severe dry eye disease. However, its effectiveness in managing postoperative dry eye remains debated. This systematic review and meta-analysis aimed to evaluate the efficacy of topical CsA in managing dry eye symptoms and signs after cataract surgery. Methods Randomized controlled trials (RCTs) assessing topical CsA in cataract surgery patients were identified through searches of PubMed, EMBASE, Web of Science, ClinicalTrials.gov, the Cochrane Library, and Google Scholar up to August 31, 2024. Outcomes included postoperative tear break-up time (TBUT), Schirmer's test (with or without anesthesia), the Ocular Surface Disease Index (OSDI), corneal fluorescein staining, and treatment-related adverse events. Results Nine RCTs involving 451 patients (558 eyes) were included. Topical CsA was significantly associated with prolonged TBUT (mean difference [MD] = 1.95 s, 95% confidence interval [CI]: 1.38 to 2.53, P < 0.001), improved Schirmer's test scores without anesthesia (MD = 2.14 mm, 95%CI: 0.68 to 3.59, P = 0.004), and reduced corneal fluorescein staining (standardized MD = - 1.62, 95%CI: - 3.16 to - 0.08, P = 0.039). However, CsA did not significantly improve Schirmer's test scores with anesthesia (MD = 1.73 mm, 95%CI: - 0.11 to 3.56 to 2.79, P = 0.066) or OSDI scores (MD = - 2.73, 95%CI: - 7.42 to 1.97, P = 0.255) compared to control. All treatment-related adverse events were mild. Conclusion Topical CsA significantly improves ocular surface and tear film parameters following cataract surgery and may be considered for the postoperative management of ocular surface disturbance and dry eye. However, considering the very low to moderate certainty of evidence, further high-quality RCTs are needed to validate for these findings.