Adjunctive 0.1% Cyclosporine with Early Steroid Tapering After Combined Vitrectomy and Cataract Surgery for Idiopathic Epiretinal Membrane

Purpose: To evaluate postoperative dry eye outcomes associated with adjunctive topical 0.1% cyclosporine A (CsA) combined with early steroid tapering in patients undergoing combined pars plana vitrectomy (PPV) and cataract surgery for idiopathic epiretinal membrane (ERM). Methods: This retrospective study included 40 eyes of 40 patients who underwent combined 25-gauge PPV with ERM peeling and cataract surgery. Patients were managed with one of two postoperative regimens according to routine clinical practice: Group 1 received topical 0.1% CsA with early tapering and discontinuation of topical prednisolone acetate at 5 weeks, whereas Group 2 received prolonged topical prednisolone acetate monotherapy for 2 months. Ocular Surface Disease Index (OSDI), non-invasive tear breakup time (NIBUT), lipid layer thickness (LLT), tear meniscus height (TMH), partial blink ratio, best-corrected visual acuity (BCVA), intraocular pressure (IOP), and central macular thickness (CMT) were evaluated preoperatively and postoperatively. Results: Significant changes over time were observed for BCVA (p = 0.002), OSDI (p = 0.005), and CMT (p = 0.016). A significant time-by-group interaction was observed for OSDI (p = 0.012). Post-hoc analysis showed that OSDI changes differed significantly between groups during the 1- to 2-month postoperative interval (p = 0.002) and from baseline to 2 months (p = 0.015). The between-group difference in OSDI change from baseline to 2 months was -14.9 points (95% confidence interval, -26.9 to -2.9). No significant between-group differences were observed in NIBUT, LLT, TMH, partial blink ratio, or CMT trends during follow-up. No severe postoperative complications were observed. Conclusions: Early steroid tapering combined with adjunctive topical 0.1% CsA may represent a potential postoperative management strategy for ocular discomfort in selected patients undergoing combined surgery for idiopathic ERM. Further prospective studies are required to validate these findings.