Comment on: Comparison of postoperative cyclosporine 2.0% versus betamethasone 0.1% eye drops following trabeculectomy: A randomized clinical trial

Dear Editor, We read the article titled “Comparison of postoperative cyclosporine 2.0% versus betamethasone 0.1% eye drops following trabeculectomy: A randomized clinical trial”[1] published in IJO in March 2025. The study provides valuable insights into postoperative management following trabeculectomy and highlights the potential of cyclosporine A 2% as a promising alternative to corticosteroids. The study’s comprehensive evaluation of outcomes, including intraocular pressure control, bleb morphology, surgical success rates, and ocular surface health, offers a holistic understanding of postoperative recovery. In particular, the focus on cyclosporine A 2% as a potential steroid-sparing alternative aligns well with current efforts to minimize steroid use, making this meaningful. However, we wish to raise concerns regarding the blinding process in this triple-masked trial. As reported, the study compares betamethasone 0.1%, a clear aqueous solution, with cyclosporine A 2%, which is formulated as a milky-white emulsion. This difference in physical characteristics may be readily apparent to both patients and administering personnel, potentially compromising the blinding integrity. Additionally, while the efficacy outcomes are well described, the study does not provide details on the tolerability or adverse effects associated with the use of cyclosporine A 2%.[2,3] Given the known potential for ocular irritation and discomfort with higher concentrations of topical cyclosporine, reporting on adverse events would aid in the clinical utility and safety of this treatment. Another aspect which is not clear is the compliance of patients. While the study provides valuable insights into cyclosporine’s role following trabeculectomy, addressing these concerns will pave the way for further research.