Ocular surface disease management in cataract surgery

Purpose: According to the literature, 80% of patients undergoing cataract surgery suffer from ocular surface disease (OSD). Along with postoperative refractive surprise, the onset of OSD is the main cause of dissatisfaction in cataract surgery patients, accounting for 35% of cases. These patients are characterized by persistent dysregulation of ocular surface para-inflammation, leading to chronic low- grade inflammation with significant consequences on daily activities and work productivity. This study aims to investigate the effects of topical desonide sodium phosphate 0.025% eye drops on the signs and symptoms of OSD in patients undergoing cataract surgery. Methods: A multi center randomized controlled trial was conducted. Cataract patients without ocular comorbidities were consecutively enrolled and randomized into two groups. Both groups underwent phacoemulsification with standard postoperative therapy (levofloxacin 0.5% eye drops six times a day for 5 days and dexamethasone sodium phosphate 0.15% eye drops four times a day for 1 week and then twice a day for 1 week). Additionally, the study group received lubricating eye drops containing xanthan gum 0.2% and desonide sodium phosphate 0.025% three times a day, while the control group received hyaluronic acid 0.15% three times a day. At patient enrollment (T0), 1 day (T1), 2 weeks (T2), and 1 month after surgery (T3), signs and symptoms of OSD and tear function tests were recorded. Results: OSDI scores significantly worsened at T1 in both groups (study: 28.4 ± 2.1 to 75.7 ± 5.7; control: 26.3 ± 1.8 to 68.0 ± 6.9; p<0.001) but improved more rapidly in the study group, reaching 12.0 ± 3.0 at T3 vs. 30.9 ± 5.4 in controls (p<0.001). T-BUT improved from 6.0 ± 0.8 s at T1 to 11.9 ± 1.0 s at T3 in the study group, outperforming the control group (4.9 ± 0.9 s to 7.8 ± 0.5 s, p<0.001). Schirmer’s test showed better recovery in the study group (18.2 ± 1.3 mm to 16.3 ± 1.3 mm) compared to controls (16.8 ± 1.1 mm to 6.8 ± 1.3 mm, p<0.001). No adverse events or intraocular pressure changes were observed. Conclusions: The addition of desonide sodium phosphate 0.025% with xanthan gum 0.2% significantly improved OSD signs and symptoms post-cataract surgery, offering an effective, well-tolerated treatment with a favorable safety profile.