Potential Neurosensory Modulation By Topical Citicoline In Postoperative Dry Eye Following Cataract Surgery

This study aimed to evaluate the potential effect of topical citicoline eye drops on postoperative ocular surface parameters in patients undergoing cataract surgery, with particular focus on dry eye severity and tear film stability.

This study was performed at the Eye Department of General Hospital “Dr Josip Bencević” and included individuals undergoing elective cataract surgery. Clinical evaluations were performed in a standardized setting with consistent diagnostic equipment and postoperative care regimen. Patients were followed for one month after the surgical procedure.

Seventy patients undergoing uneventful phacoemulsification were prospectively evaluated. Following uneventful phacoemulsification, all patients received standard postoperative therapy and topical citicoline three times daily for one month. Ocular surface parameters were evaluated before and one month after surgery using the SPEED questionnaire (graded 1–3), the Schirmer test (graded 1–4), and tear break-up time (TBUT; graded 1–3). Data were summarized using appropriate descriptive measures, and changes between preoperative and postoperative assessments were analyzed. Transitions within severe categories were examined, and the influence of age, sex, and diabetes mellitus on postoperative changes was assessed.

Postoperative assessment demonstrated a significant improvement in Schirmer scores (p = 0.029), indicating reduced dry eye severity. The proportion of patients with severe subjective symptoms (SPEED grade 3) significantly decreased following surgery (p = 0.023). In contrast, TBUT showed significant deterioration (p = 0.001), accompanied by a marked increase in cases of severe tear film instability (p = 0.001). Age, sex, and diabetes mellitus were not associated with postoperative changes in ocular surface parameters.

Cataract surgery was associated with postoperative deterioration of tear film stability despite improvement in subjective symptoms and aqueous tear secretion. The observed reduction in severe subjective symptoms, together with the significant improvement in Schirmer scores, is compatible with a potential neurosensory modulatory effect of citicoline on the aqueous tear component; however, tear film stability, as reflected by TBUT, remained impaired. Further controlled studies are required to clarify the specific role of citicoline in postoperative ocular surface recovery.