The effect of 3% diquafosol on the improvement of ocular surface post cataract surgery: A meta-analysis for time of intervention

PURPOSE: The effect of interventional time for 3% Diquafosol reatment in post-cataract surgery has not been well established. A meta-analysis was performed to evaluate the improvement of ocular surface condition in post-cataract surgery patients who received 3% DQS for various treatment durations. METHODS: Studies were performed based on 5 databases: PubMed, Cochrane Library, Web of Science, Embase, and China National Knowledge Infrastructure. Data on changes in Schirmer’s test, tear breakup time (TBUT), corneal staining score, and OSDI score were collected for meta-analysis. RESULTS: A total of 621 affected eyes from 9 independent clinical studies were included. 6 studies conducted Schirmer's test after the application of 3% DQS. Meta-analysis showed that the difference between 3% DQS and control groups was not statistically significant for short-term application (less than or equal to 1 month) (WMD ​= ​0.14, P ​= ​0.27, 95% CI:-0.11 to 0.39), but was statistically different for long-term application (longer than or equal to 3 months) (WMD ​= ​0.76, P ​= ​0.03, 95% CI:0.08 to 1.45). For the corneal fluorescence staining score, the data from 6 studies indicated that the improvement was statistically significant for short-term application (WMD ​= ​-0.40, P <0.00001, 95% CI:-0.72 to -0.08) and but not long-term application (WMD ​= ​-0.21, P ​= ​0.26, 95% CI:-0.57 to 0.15). For TBUT, the data from 9 studies indicated that both short-term and long-term application showed significant improvement (WMD ​= ​1.70, P <0.00001, 95% CI:1.38 to 2.03; WMD ​= ​1.52, P <0.00001, 95% CI:1.09 to 1.95). Similar results were observed in data from 5 studies with OSDI scores, where both short-term and long-term application showed statistically significant improvements (WMD ​= ​-5.41, P <0.00001, 95% CI: -7.02 to -3.81; WMD ​= ​-6.10, P <0.00001, 95% CI:-8.52 to -3.67). CONCLUSIONS: The application of 3% DQS in post-operative cataract patients has a positive effect on improving the ocular surface conditions. Short-term application resulted in lower corneal staining scores, prolonged TBUT, and improved OSDI scores. Long-term application improved Schirmer's test results, TBUT, and subjective symptoms. KEY MESSAGES: The updated article suggests that 3% Diquafosol is less effective in the short term after cataract surgery, and that application over three months can improve the patient's ocular surface condition.