Efficacy of autologous serum in managing post-cataract dry eye: an in vivo confocal microscopy-based comparative analysis

Clinical Relevance Postoperative dry eye disease is a common and clinically significant complication of cataract surgery that can impair visual recovery and reduce patient quality of life. Effective management of ocular surface inflammation in this patient population remains an important challenge in clinical practice.Background The aim of this work is to compare the efficacy of 20% autologous serum and 0.15% preservative-free sodium hyaluronate in managing iatrogenic dry eye disease after cataract surgery, with ocular surface inflammation assessed by in vivo confocal microscopy.Methods This retrospective, non-randomised comparative study included 46 patients who developed dry eye disease within one month after phacoemulsification, receiving either 20% autologous serum (n = 24) or 0.15% sodium hyaluronate (n = 22) five times daily for four weeks. Outcomes included Ocular Surface Disease Index, tear break-up time, corneal fluorescein staining, tear meniscus height and area, and subbasal dendritic cell density by in vivo confocal microscopy.Results Both groups achieved significant improvements in all parameters (p < 0.05). At one month, autologous serum showed greater improvements than sodium hyaluronate in Ocular Surface Disease Index (11.4 ± 6.0 vs. 19.4 ± 8.3; p < 0.001), tear break-up time (9.98 ± 2.72 vs. 8.17 ± 2.56 s; p = 0.019), corneal fluorescein staining (0.67 ± 0.64 vs. 1.23 ± 0.53; p = 0.003), tear meniscus height (326.2 ± 50.4 vs. 284.1 ± 44.8 µm; p = 0.005), and dendritic cell density (37.9 ± 15.8 vs. 52.7 ± 18.6 cells/mm2; p = 0.003), with a greater mean reduction in dendritic cell density (−29.1 ± 6.6 vs. −14.0 ± 7.2 cells/mm2; p < 0.001).Conclusion Compared with sodium hyaluronate, 20% autologous serum was associated with greater improvements in clinical outcomes and a greater reduction in dendritic cell density, providing objective microstructural evidence of reduced ocular surface inflammation. Prospective randomised studies are warranted to confirm these findings.