Efficacy of Topical 0.05% Cyclosporine A for Ocular Surface Disease Related to Topical Anti-Glaucoma Medications

Purpose: We aimed to determine the therapeutic efficacy of 0.05% topical cyclosporine A (CsA) for chronic ocular surface disease (OSD) in patients using benzalkonium chloride (BAK)-preserved antiglaucoma eye drops.Methods: A prospective, randomized, paired-eye, controlled clinical trial was conducted with participants who had been instilling at least one BAK-preserved topical antiglaucoma drug in both eyes for at least 6 months. Topical CsA was only applied in randomly selected unilateral eyes. Visual field (VF) indices, ocular surface parameters, tear meniscus height (TMH), and matrix metalloproteinase-9 (MMP-9) immunoassay were evaluated at baseline and at 2 and 4 months.Results: Seventy eyes from 35 participants were included in the study. The Schirmer I, tear breakup time, and TMH increased by 4.5 +/- 8.6 mm (P < 0.01), 5.0 +/- 5.3 s (P < 0.001), and 85.4 +/- 159.0 mu m (P < 0.01) in the treated eyes at 4 months from baseline, respectively. The ocular staining score and MMP-9 positivity in the treated eyes decreased by 2.2 +/- 1.3 (P < 0.001) and 0.7 +/- 0.9 points (P < 0.001), respectively, at 4 months. In untreated eyes, only TMH increased by 41.4 +/- 92.1 mu m (P = 0.016) from baseline to 4 months. In VF indices, the tracking failure frequency was 19.09% +/- 21.62%, and the test duration was 336.0 +/- 79.5 s in the treated eyes at 4 months, which were lower than 34.37% +/- 23.13% (P < 0.001) and 375.9 +/- 70.7 s (P < 0.05) in the nontreated eyes.Conclusion: Application of topical 0.05% CsA significantly improved the OSD parameters and the reliability indices of VF tests. This study was registered with the Clinical Research Information Service (CRIS) (number KCT0007124).