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

Authors: Zhang Y, Qi Y, Xie X, Zhang F.

Geographical coverage: Not reported

Sector: Post-operative care

Sub-sector: Ocular surface management

Equity focus: Not reported

Study population: Adults with cataracts who had undergone conventional cataract surgery

Review type: Effectiveness review

Quantitative synthesis method: Meta-analysis

Qualitative synthesis method: Not applicable

Background:

Cataract surgery, while effective in restoring vision, often leads to postoperative ocular surface abnormalities due to factors like intraoperative irrigation, ultrasound energy, and the use of NSAID eye drops. These can cause symptoms such as dryness, discomfort, and visual fatigue, which diminish patients’ quality of life. Traditional artificial tears offer limited relief, primarily replenishing aqueous fluid without addressing the full spectrum of symptoms. Diquafosol sodium, a P2Y2 receptor agonist, promotes both aqueous and mucin secretion and supports corneal epithelial repair, making it a promising treatment for dry eye conditions. Although previous studies suggested its potential benefits, the optimal timing and duration of DQS application post-surgery remained unclear.

Objectives:

To clarify the therapeutic effects of 3% DQS administered at different postoperative intervals by synthesising data from recent clinical studies.

Main findings:

The review included nine studies—eight RCTs and one retrospective study—analysing 621 eyes (307 treated with DQS, 314 controls).

Quality assessment found two RCTs high quality; six lacked blinding. The retrospective study was high quality per the Newcastle-Ottawa Scale.

Schirmer’s test (short-term: no significant difference; long-term: significant improvement with DQS).
Corneal staining (short-term: significant improvement; long-term: no significant difference).
TBUT (both short- and long-term: significantly improved with DQS).
OSDI (short- and long-term: significantly improved with DQS).

Sensitivity analysis confirmed robustness; no publication bias was detected. Results support both short- and long-term benefits of DQS on ocular surface health post-surgery.

Methodology: 

Systematic search of PubMed, Cochrane Library, Web of Science, Embase, and CNKI up to 2021. Included studies evaluated 3% DQS in post-cataract patients, reporting on Schirmer’s test, TBUT, corneal staining, or OSDI.

Two reviewers screened studies; disagreements were resolved by a third. Risk of bias assessed using Cochrane and Newcastle-Ottawa tools. Meta-analysis used RevMan 5.3, with fixed or random effects based on heterogeneity. Subgroup analysis examined treatment duration. Sensitivity analysis and funnel plots assessed robustness and publication bias.

Applicability/external validity:

Authors did not discuss applicability or generalisability. Although comprehensive, the review’s findings may be limited by short follow-up periods, non-standardised postoperative protocols, and lack of demographic or geographic detail. These factors reduce the review’s external validity.

Geographic focus:

The review did not report on the location of studies included.

Summary of quality assessment:

Overall, we have low confidence in the conclusions about the effects of 3% diquafosol following cataract surgery. The search lacked clarity on publication status and grey literature. Data extraction procedures were insufficiently described, and no exclusion list was reported. Although meta-analytic techniques were appropriate, the review did not analyse risk of bias results or explore heterogeneity beyond treatment duration.