Trehalose and Dry Eye Disease: A Comprehensive Systematic Review of Randomized Controlled Trials

The purpose of the research project was to extensively review the efficacy and safety of a trehalose tear-substitute treatment in cases of dry eye disease (DED). A systematic review that included only full-length randomized controlled studies (RCTs) reporting the effects of trehalose tear-substitute treatment in three databases, PubMed, Scopus and Web of Science, was performed according to the PRISMA statement. The search period included papers published before 8 August 2023. The Cochrane risk-of-bias tool was used to analyze the quality of the studies selected. A total of 10 RCTs were included in this systematic review. Trehalose tear-substitute treatments achieved a higher improvement than did control group interventions in all reported variables. The mean differences between both groups were in favor of trehalose, and were as follows: ocular surface disease index (OSDI) questionnaire score of -8.5 +/- 7 points, tear film breakup time (TBUT) of 1.9 +/- 1 s, tear film thickness (TFT) of 0.25 +/- 0.1 mu m, tear meniscus height (TMH) of 0.02 +/- 0.02 mm, Schirmer test (ST) of 0.8 +/- 1.4 mm, corneal fluorescein staining (CFS) of -0.7 +/- 0.1 points and visual acuity (VA) of 0.3 +/- 2.1 letters. No adverse events after trehalose tear-substitute treatments were reported. Trehalose tear substitutes are a safe and effective treatment for DED. Therefore, trehalose tear substitutes should be recommended for patients with dry eye disease. In addition, there is specific evidence to support its use in the preoperative cataract surgery period.