A Randomized Multicenter Study Comparing 0.1%, 0.15%, and 0.3% Sodium Hyaluronate with 0.05% Cyclosporine in the Treatment of Dry Eye

Abstract

Purpose: To investigate the efficacy of 0.1%, 0.15%, and 0.3% sodium hyaluronate (SH) artificial tears compared with 0.05% cyclosporine (CS) ophthalmic solution for the treatment of dry eye.

Methods: One hundred seventy-six patients were recruited and randomized to receive of 0.1%, 0.15%, and 0.3% SH and 0.05% CS. There was a primary end point which is the changes in the fluorescein corneal staining (FCS) score to determine noninferiority of 0.1%, 0.15%, and 0.3% SH. Secondary objective end points were lissamine green conjunctival staining (LGCS) scores, Schirmer test, and tear film break-up time (TBUT). Secondary subjective end point was ocular surface disease index (OSDI) score. These were evaluated before treatment and 6 and 12 weeks after start of treatment.

Results: In the primary analysis, the mean change from baseline in FCS scores verified noninferiority of 0.1% and 0.15% SH to 0.05% CS and also indicated significant improvement of all groups (P < 0.05). Values for TBUT, LGCS scores, and OSDI scores showed significant improvements in all groups (P < 0.05), although no significant intergroup difference was shown. However, Schirmer test scores in the 0.15% SH group showed a significant tendency for better improvement at week 12 compared with the other groups (P < 0.05). No serious adverse events were observed.

Conclusions: Administration of 0.1%, 0.15%, and 0.3% SH was effective in improving both the objective signs and subjective symptoms of dry eye. Those findings, in addition to the well-tolerated profile of 0.1%, 0.15%, and 0.3% SH, show that it is effective therapeutic method for dry eye.

Keywords: 0.05% cyclosporine; 0.1% sodium hyaluronate; 0.15% sodium hyaluronate; 0.3% sodium hyaluronate; dry eye syndrome.

FIG. 1.

Fluorescein (a) and lissamine green (b) staining score changes from the baseline value. Mean value ± standard error. The decrease in fluorescein and lissamine green staining scores in all groups was statistically significant at week 6 and 12 (P < 0.05).

FIG. 2.

TBUT (a) and Schirmer I score (b) change from the baseline. Mean value ± standard error. The increase in TBUT (s) in all groups was statistically significant at week 6 and 12 (P < 0.05). There was no significant difference in the increase in the TBUT between groups at week 6 and 12. The increase in the Schirmer I score in 0.15% SH was statistically significant at week 12 (P < 0.05). SH, sodium hyaluronate; TBUT, tear film break-up time.

FIG. 3.

OSDI score change from the baseline. Mean value ± standard error. The decrease in the OSDI score in all groups was statistically significant at week 6 and 12 (P < 0.05). OSDI, ocular surface disease index.