Comparison of Rebamipide Clear Solution and Diquafosol Eyedrops in Dry Eye Disease with Short Tear Break-up Time: A Retrospective, Comparative Observational Study.

PURPOSE: To compare the efficacy of 2% rebamipide clear solution and 3% diquafosol eyedrops in dry eye disease (DED) patients with short tear break-up time (tBUT).

METHODS

This nonrandomized retrospective, comparative observational study included 120 eyes (60 patients) divided into Group 1 (2% rebamipide, 60 eyes) and Group 2 (3% diquafosol, 60 eyes). Evaluations at baseline, 1 month, and 3 months included Ocular Surface Disease Index Questionnaire (OSDI), Schirmer I, noninvasive tBUT (NItBUT), corneal/conjunctival staining score, meiboscore, meibum expressibility and quality, lipid thickness, tear meniscus height (TMH), impression cytology, and goblet cell density. The primary endpoint was NItBUT change at 3 months.

RESULTS

Both groups showed significant improvement (P < 0.025, Bonferroni correction) in DED signs and symptoms at 1 and 3 months compared with baseline. Changes from baseline were comparable between groups for OSDI, NItBUT, corneal and conjunctival staining score, meiboscore, meibum expressibility and quality, lipid thickness, impression cytology, and goblet cell density (P > 0.05). At 3 months, group 2 showed greater increases in aqueous-related parameters than group 1 (for Schirmer I, adjusted mean differences 1.31 mm, 95% CI: 0.49-2.13, P = 0.002; for TMH, adjusted mean differences 0.05 mm, 95% CI: 0.01-0.09, P = 0.014).

CONCLUSION

In patients with short tBUT DED, both rebamipide clear solution and diquafosol eyedrops showed comparable improvement in the primary endpoint, NItBUT at 3 months, as well as in other ocular surface parameters. Under standard dosing regimens, however, diquafosol was associated with greater increases in Schirmer I test values and TMH than rebamipide clear solution.