Comparative Efficacy of Diquafosol, Rebamipide, and Carboxymethylcellulose in Patients with Pre-existing Dry Eye Disease Undergoing Cataract Surgery

Purpose: To compare the clinical efficacy of 3% diquafosol, 2% rebamipide, and 0.5% carboxymethylcellulose (CMC) in patients with pre-existing dry eye disease (DED) undergoing cataract surgery. Methods: This retrospective study included 75 eyes of 75 patients with DED undergoing cataract surgery, divided into diquafosol (n=25), rebamipide (n=25), and CMC (n=25, control) groups based on prescribed eye drops, administered four times daily from 2 weeks before surgery to 4 weeks after surgery. Tear film break-up time (TBUT), ocular surface staining, meibomian gland secretion (MGS), lid margin telangiectasia, Schirmer test, and Ocular Surface Disease Index (OSDI) were evaluated preoperatively and at 4 weeks postoperatively. Results: All parameters improved significantly in all groups at 4 weeks (all p<0.001). Diquafosol showed greater improvement than CMC in TBUT and OSDI (p=0.001 and <0.001), and greater TBUT improvement than rebamipide (p=0.017); the difference in corneal staining did not reach significance in the overall three-group comparison (p=0.053). Rebamipide showed greater improvement than CMC in MGS (p=0.018), lid margin telangiectasia (p<0.001), Schirmer test (p=0.005), and OSDI (p=0.001), and greater improvement than diquafosol in lid margin telangiectasia and Schirmer test (p=0.002 and 0.036, respectively). Conclusions: Both diquafosol and rebamipide were more effective than CMC in stabilizing the ocular surface after cataract surgery in patients with pre-existing DED. Diquafosol is advantageous for rapid tear film stabilization, whereas rebamipide is associated with greater improvement in eyelid margin telangiectasia grade and meibomian gland secretory function, suggesting that perioperative eye drop selection should be individualized.