Trehalose in Hyaluronic Acid Eye Drops May Benefit Dry Eye After Cataract Surgery

Male doctor doing cataract surgery in operating room
Research shows the treatment provides swift recovery of inflammation from corneal fibres.

For patients undergoing cataract surgery, adding 3% trehalose to 0.15% hyaluronic acid eye drops may effectively help reduce inflammation and signs and symptoms of dry eye, according to research published in the Journal of Cataract & Refractive Surgery.

Fixed trehalose and hyaluronic acid have been of therapeutic interest for tear substitutes in patients with postoperative dry eye; however, the efficacy of combining these 2 molecules for the reduction of signs and symptoms of dry eye and corneal inflammation has not been well studied in patients who have undergone cataract surgery. 

A team of investigators in Italy conducted a prospective, randomized, open-label, comparative analysis in patients undergoing unilateral cataract surgery and intraocular lens implantation to determine whether the addition of trehalose to hyaluronic acid-containing drops would improve patient outcomes.

A total of 98 patients were randomly assigned (1:1:1) to either receive trehalose 3%/hyaluronic acid 0.15% eye drops twice daily for 60 days (group A; n=33), unpreserved hyaluronic acid 0.15% eye drops twice daily for 60 days (group B; n=33), or no tear substitutions (group C; n=32). The ocular surface disease index (OSDI) and confocal microscopy (IVCM) were performed prior to surgery and at 1, 4, and 8 months after surgery. 

At 1 month follow-up, there was a significant increase in Schirmer test from baseline among group A participants (P <.05), but no significant changes were observed in groups B or C. Similarly, tear break-up time significantly increased at month 1 compared to baseline in group A but not significantly in groups B and C. 

The OSDI scores significantly decreased at month 1 in group A, and at month 4 in groups B and C. Corneal epithelial cell density reached baseline levels at month 4 for group A and was significantly higher than baseline levels by month 8. No significant changes were observed in group B and corneal epithelial cell density reached baseline levels at month 4 in patients in group C; however, this increase was not statistically significant.

When assessing the subbasal nerve plexus and the number of subbasal nerve fibers compared with basal nerve fibers, group A had a progressive reduction in the tortuosity of the nerve fibers of the subbasal plexus, which was significantly different from basal values from month 4 of follow-up. These values were significantly lower than group B or C, with similar results for the reflectivity of subbasal nerve fibers. 

Finally, groups B and C had more Langerhan cells and activated stromal keratocytes throughout the follow-up period and significantly lower density of hyperreflective stromal cells as compared with group A. 

“Overall, these results show that cataract surgery induces widespread and persistent inflammation of the corneal-conjunctival surface, leading to dry eye associated signs and symptoms,” according to the research. “These study results suggest that 3% trehalose/0.15% HA could be regarded as a useful tool in postoperative therapeutic management following cataract surgery.”


Cagini C, Di Lascio G, Giovanni T, et al. Dry-eye and inflammation of the ocular surface after cataract surgery: study on the effectiveness of a tear substitute based on trehalose/hyaluronic acid versus hyaluronic acid in the resolution of signs and symptoms. J Cataract Refract Surg. Published online March 18, 2021. doi:10.1097/j.jcrs.0000000000000652