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.