Additive Effect of Preservative-free Sodium Hyaluronate 0.1% in Treatment of Dry Eye Syndrome With Diquafosol 3% Eye Drops

Purpose: The aim of this study was to evaluate the treatment effect of diquafosol 3% with preservative-free sodium hyaluronate 0.1% eye drops in dry eye syndrome. Methods: In total, 150 patients with dry eye syndrome were divided randomly into 3 groups. Group 1 (50 patients) was treated 4 times daily with preserved sodium hyaluronate 0.1%, group 2 (50 patients) was treated 4 times daily with diquafosol 3%, and group 3 (50 patients) was treated 4 times daily with diquafosol 3% and preservative-free sodium hyaluronate 0.1% eye drops for 3 months. Ocular surface disease index (OSDI) score, tear film break-up time, Schirmer I test, corneal fluorescein staining, and impression cytology were evaluated. Results: There were significant improvements in the OSDI score, tear film break-up time, Schirmer I score, fluorescein and Rose Bengal staining, goblet cell density, and impression cytological findings in groups 2 and 3 compared with those for group 1 in patients with dry eye syndrome at 1, 2, and 3 months (P < 0.05). There were statistically significant improvements in the OSDI score (-8.48 +/- 0.97, -5.69 +/- 0.78; P = 0.02), fluorescein (-1.43 +/- 0.21, -1.02 +/- 0.18; P = 0.03), and Rose Bengal staining (-1.12 +/- 0.26, -0.75 +/- 0.12; P = 0.03), goblet cell density (89.65 +/- 14.39, 70.36 +/- 16.75; P = 0.03), and impression cytological findings (-0.53 +/- 0.12, -0.34 +/- 0.90; P = 0.01) in group 3 compared with those in group 2 at 3 months. Conclusions: Treatment with diquafosol 3% with preservative-free sodium hyaluronate 0.1% was more effective than diquafosol 3% monotherapy or treatment with preserved sodium hyaluronate 0.1% in dry eye syndrome. Preservative-free sodium hyaluronate 0.1% eye drops can increase the effect of diquafosol 3% in dry eye syndrome.