Neuroprotective And Anti-Inflammatory Strategies For Corneal Nerve Regeneration And Ocular Surface Stability After Corneal Refractive Surgeries: A Systematic Review
Published 2026 - 44th Congress of the ESCRS
Reference: FP31.06 | Type: Free paper | DOI: 10.82333/b5ma-p720
Authors: Dr Anas Alamoudi* 1 , Dr Abdulaziz Khalid Aldahlawi 1 , Dr Ahmed Alnabihi 2 , Dr Rozan Abdulaziz AlGhamdi 3 , Dr Hind Mohammed Aljabri 4 , Dr Naif Almufarriji 5 , Dr Rahaf Khder Sharif 6 , Dr Danah Albreiki 5 , Dr Bader AlQahtani 7
1Department of Ophthalmology,Jeddah Eye Hospital,Jeddah,Saudi Arabia, 2Department of Ophthalmology,King Khaled Eye Specialist Hospital and Research Center,Riyadh,Saudi Arabia, 3Department of Ophthalmology,East Jeddah Hospital,Jeddah,Saudi Arabia, 4College of Medicine,King Saud bin Abdulaziz University for Health Sciences,Jeddah,Saudi Arabia, 5Department of Ophthalmology,King Fahad Medical City,Riyadh,Saudi Arabia, 6Department of Ophthalmology,King Abdulaziz Medical City, National Guard Health Affairs,Riyadh,Saudi Arabia, 7College of Medicine,Alfaisal University,Riyadh,Saudi Arabia
Purpose
This study aimed to systematically synthesize and critically appraise all controlled trials evaluating neuroprotective and anti-inflammatory pharmacotherapies for enhancing corneal nerve regeneration and ocular surface stability following corneal keratorefractive surgeries.
Setting
A systematic review.
Methods
We registered a PROSPERO-guided protocol (CRD42024610462) and systematically searched PubMed, Embase, Scopus, and Web of Science from inception to March 2024 for randomized controlled trials (RCTs) evaluating neuroprotective or anti-inflammatory pharmacotherapies after LASIK, PRK, LASEK, or femto-LASIK. Two independent reviewers screened records, extracted data, and assessed risk of bias using the RoB 2 tool.
Results
Seven trials (n=484 participants/eyes, six countries) met eligibility. (Evidence certainty limited by small, heterogeneous RCTs.) Topical cyclosporine 0.05% (two RCTs) consistently hastened flap sensitivity recovery (Δ+4 cm at 3 months) and improved 6-month ocular surface metrics (OSDI −5 points; TBUT +4 s; Schirmer +5.5 mm; p<0.001). Topical diclofenac 0.1% reduced PRK pain by ~50% within 24 hours without delaying epithelial closure. Topical citicoline 1% accelerated sensory normalization by 2 weeks and transiently enhanced Schirmer/TBUT. Oral pregabalin (150 mg BID) and oral gabapentin (300 mg perioperatively) reduced first-week pain after surface ablation yet had no measurable impact on nerve metrics or dry eye indices through 6 months.
Conclusions
Among tested strategies, topical cyclosporine provides the strongest evidence for enhancing corneal nerve function and long-term tear film stability after keratorefractive surgery. However, overall evidence remains limited. Larger, double-masked trials with extended follow-up are needed to further elucidate the roles of these interventions.