Abstract
Introduction
Postoperative dry eye can impair visual recovery and patients' perceived benefit after cataract surgery. We compared topical eye-drop regimens across tear-film stability, tear secretion, corneal epithelial damage, and patient-reported symptoms.Methods
A PROSPERO-registered review searched nine databases from inception to January 30, 2026, for randomized trials of ocular-surface treatments after cataract surgery. Frequentist random-effects network meta-analyses assessed 1-month tear-film breakup time, Schirmer test, corneal fluorescein staining, and Ocular Surface Disease Index; safety was summarized descriptively.Results
Forty-seven trials (102 arms; 4920 eyes assessed; 4844 arm-level analyzed observations) were included; 38 trials (81 arms; 3898 analysis units) contributed to network meta-analyses within a 19-node framework. Compared with routine postoperative care, moderate-confidence evidence indicated greater tear-film breakup time with diquafosol plus hyaluronic acid (mean difference 4.17 s, 95% confidence interval 1.99-6.35) and cyclosporine plus carboxymethylcellulose (3.97 s, 1.60-6.34), whereas low-confidence evidence suggested a possible increase with cyclosporine plus deproteinized calf blood extract (4.98 s, 1.93-8.03). Outcome-specific benefits were observed for tear secretion and corneal staining, whereas symptom findings were exploratory. Most top-ranked treatment nodes across the four networks were informed by only one or two trials with few analysis units. Some estimates were affected by high risk of bias or local incoherence. No statistically significant global inconsistency was detected overall.Conclusions
No single topical regimen showed consistently favorable effects across all postoperative ocular-surface outcomes. Outcome-specific signals require confirmation because sparse direct evidence, risk of bias, and limited safety and longer-term data preclude definitive recommendations. Adequately powered head-to-head trials with standardized postoperative care are needed for future clinical guidance.Trial registration
PROSPERO CRD42026138249.