Topical cyclosporine treatment enhances outcomes of multifocal IOL implantation

A 3-month regimen of topical treatment with cyclosporine ophthalmic emulsion 0.05% (Restasis, Allergan) administered pre- and postoperatively significantly improves visual outcomes in cataract surgery patients with a multifocal IOL implanted, reported Eric D. Donnenfeld, MD, a private practitioner in Rockville Centre, NY.

Dr. Donnenfeld investigated the potential benefit of topical cyclosporine treatment in cataract surgery patients in a prospective, randomized, contralateral eye controlled study. Fourteen patients ages 50 years and older (mean 66 years) undergoing bilateral phacoemulsification and implantation of the refractive multifocal IOL (ReZoom, Advanced Medical Optics) had one eye randomized to twice daily treatment with topical cyclosporine and used artificial tears in the fellow eye. The study agents were started 1 month prior to first eye surgery, the second eye surgery was performed 2 weeks after the first, and use of the cyclosporine and artificial tears was continued for 2 months postop.

At the end of the treatment period, visual acuity outcomes were significantly better in the cyclosporine-treated eyes compared to the controls for both mean logMAR UCVA (cyclosporine 0.11, artificial tears 0.19; p = 0.045) and mean logMAR BCVA (cyclosporine 0.0, artificial tears 0.1; p = 0.005). The results of contrast sensitivity testing performed under photopic and mesopic conditions with and without glare also consistently favored use of cyclosporine at all spatial frequencies, and some of the differences were statistically significant or trended toward significance. In addition, patient satisfaction was greater in the cyclosporine-treated eye. Ten patients (71%) expressed a preference for one eye versus the other, and among those patients, the cyclosporine-treated eye was preferred 4:1 over the eye treated with artificial tears.

"All vision starts with the tear film and so improving the tear film will improve quality of vision," Dr. Donnenfeld said. "This is particularly important for patients implanted with multifocal IOLs that are associated with some degradation of vision due to the nature of their optics."

"This study shows topical cyclosporine A improves the tear film sufficiently to improve the optics of the eye, and it supports the idea that improving the tear film is the most important step clinicians can take in improving visual outcomes in multifocal IOL recipients," Dr. Donnenfeld concluded.