Comparison of the efficacy of intense pulsed light, 0.05% cyclosporine A eye drops, and 3% diquafosol sodium eye drops in the treatment of moderate to severe dry eye: A prospective cohort study

The study aimed to compare the efficacy of intense pulsed light (IPL), 0.05% cyclosporine A (CsA) eye drops, and 3% diquafosol sodium (DQS) eye drops in treating moderate to severe dry eye. A cohort of 180 patients diagnosed with moderate to severe dry eye was enrolled in the Department of Ophthalmology at Quzhou People's Hospital between October 2, 2023, and October 2, 2024. The patients were randomly assigned to 3 treatment groups: IPL, 0.05% CsA, and 3% DQS, with each group consisting of 60 patients. Ocular surface parameters were assessed at 4-week and 12-week intervals after the initiation of treatment. The primary outcome measure was the change in the corneal fluorescein staining score (CFSS), used to evaluate the therapeutic efficacy of IPL, 0.05% CsA, and 3% DQS eye drops. The secondary outcomes included the Ocular Surface Disease Index (OSDI), Schirmer Tear Test 1 (STT1), tear meniscus height (TMH), and tear breakup time, used to evaluate treatment efficacy. At week 4 post-treatment, the CsA, DQS, and IPL groups demonstrated statistically significant differences in average NBUT, OSDI score, TMH, and STT1 score (P < .05). The IPL group achieved the most favorable outcomes, showing the highest NBUT, TMH, and STT1 scores, along with the lowest OSDI score. Although CFSS values varied among the groups, the differences were not statistically significant (P > .05). At week 12 post-treatment, significant differences (P < .05) were observed among the CsA, DQS, and IPL groups across multiple parameters. The IPL group continued to show superior results, with the highest tear film breakup time, TMH, and STT1 scores, as well as the lowest OSDI and CFSS values. IPL, 0.05% CsA, and 3% DQS eye drops are effective in treating moderate to severe dry eye. Notably, IPL shows significant advantages over CsA and DQS, owing to its noninvasive nature, effective clearance of meibomian gland obstruction, and marked improvement in tear film quality.