Combined Cyclosporine and Loteprednol Improves Corneal Higher-Order Aberrations

Combined cyclosporine 0.1% and loteprednol 0.2% improves corneal higher-order aberrations (HOAs) better than cyclosporine 0.05% alone, according to a study published in Clinical Ophthalmology.

Prior research has shown that cyclosporine and steroids help manage dry eye. Treatments involve limited tolerability and high costs. Researchers in this prospective study completed the first comparison of cyclosporine 0.1% and loteprednol 0.2% in a chondroitin sulfate vehicle and cyclosporine 0.05%.

Fifty-six adult patients enrolled in the study at Harvard Eye Associates (n=19), Cleveland Eye Clinic (n=19), or Inland Eye Specialists (n=18). Patients were randomly assigned to cyclosporine A–loteprednol etabonate (CsA–LE; n=37) or cyclosporine A 0.05% alone (CsA; n=19). For 4 weeks, each eye of each patient received 1 drop of medication, twice daily. The researchers assessed the patients at baseline, and at 2 and 4 weeks after treatment.

Between baseline and week 2, and between baseline and week 4, total corneal HOAs improved in the central 6 mm of the cornea in the combined cyclosporine and loteprednol group and not in the CsA group.

The portion of patients who had mean tear breakup time (TBUT) of less than 5 seconds decreased for the combined cyclosporine and loteprednol group at 2 weeks and 4 weeks. In the CsA alone group, TBUT reached a statistically significant decrease at 4 weeks.

LogMAR best-corrected visual acuity (BCVA) did not vary between treatment groups. Mean BCVA improved in the combined cyclosporine and loteprednol group from baseline to week 2.

Twenty-six patients with CsA–LE and 9 with CsA reported burning/stinging. A single patient in the combined cyclosporine and loteprednol group, experienced an abnormal intraocular pressure (IOP) reading of 30 mm Hg.

Standardized Patient Evaluation of Eye Dryness (SPEED) scores, conjunctival redness, and corneal staining grade improved in both groups from baseline to endpoint, without significant differences between the drugs.

“Improvement in HOAs positively influences visual quality in all patients, but has particular relevance for patients preparing for cataract surgery because it can lead to a more accurate prediction of what lens-implant power will achieve the desired refractive result,” the study authors explain. “Patients with lower degrees of HOAs are also more likely to have a satisfactory result with today’s popular multifocal implants. A treatment like CsA–LE being shown to rapidly and significantly reduce HOAs, therefore, is particularly valuable in preparing patients for surgery, just as it is important for all patients with dry eye.”

Limitations of the study include open-label design and sample size.

Disclosure: Research InSight LLC funded this study through an independent research grant from Imprimis Rx, which did not direct the study’s design or conduct. One study author is a consultant to ImprimisRx. Each study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.