Long-Term Corneal Pachymetric Stability In Presbyopic Patients Treated With The Benozzi Method: A Real-World Longitudinal Cohort Study
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR437 | Type: Free paper | DOI: 10.82333/91h1-mf89
Authors: Dr Giovanna Benozzi* 1 , Dr Juliana Leiro 1 , Dr Florencia Lifrieri 1 , María Alejandra Montoya Giraldo 2 , A/Prof. Andrés F Zuluaga 2
1CIAP – Centro de Investigación Avanzada de la Presbicia,Buenos Aires,Argentina, 2Grupo LIME, Hospital Universitario Alma Mater & Universidad de Antioquia,Medellín,Colombia
Purpose
To determine whether chronic, long-term exposure to sodium diclofenac 0.05% combined with pilocarpine (variable strengths from 1 to 3%) within the Benozzi Method may be associated with changes in central corneal thickness (CCT) in presbyopic patients over long-term real-world use.
Setting
Single-center real-world clinical cohort of presbyopic patients treated in a chronic basis and followed between March 2012 and April 2023.
Methods
Retrospective longitudinal real-world cohort study. CCT (µm) was measured at treatment initiation and last follow-up for both eyes. All patients received chronic pharmacological treatment consisting of pilocarpine (1%, 2%, or 3%) combined with diclofenac 0.05%. Follow-up duration was calculated from dates (maximum 10 years). The primary endpoint was ΔCCT (last − baseline). Linear mixed-effects models with patient-level random intercepts accounted for inter-eye correlation and were adjusted for follow-up duration and baseline CCT to assess potential time-dependent or dose-related effects.
Results
A total of 274 eyes, from 137 patients (59.1% female; mean age 54.3±6.8 years) were analyzed. Baseline CCT was 546.7±31.0 µm and last CCT 547.6±30.1 µm, with a mean ΔCCT of +0.84±7.36 µm (median 0; IQR −2 to +3 µm). Absolute changes ≥20 µm occurred in 9 eyes (3.2%) without consistent directional pattern or progressive trajectory. No association was found between pilocarpine concentration and ΔCCT, and no dose-response effect was detected. A minimal time-related drift (~+0.7 µm/year) attenuated in sensitivity analyses.
Conclusions
Chronic exposure to diclofenac 0.05%, a component in the medication used in the Benozzi Method over extended real-world follow-up was not associated with clinically meaningful corneal thickening or thinning.
Despite theoretical concerns regarding chronic topical NSAID (diclofenac) use and corneal structural compromise, no signal of thinning, melting, or dose-dependent effect was identified. These findings support long-term pachymetric stability and structural corneal safety during sustained pharmacological treatment of presbyopia with the Benozzi Method.