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Adjunctive pirenoxine is associated with transient tear biomarker changes without sustained ocular surface benefit after refractive surgery: a randomized clinical trial

Year: 2026

Type: article

Study designs: Randomized Controlled Trial, Clinical Trial

Abstract: Adjunctive pirenoxine (PRX) was evaluated for its effects on ocular surface outcomes and tear inflammatory biomarkers after refractive surgery. In this randomized contralateral-eye trial of bilateral photorefractive keratectomy (PRK) or laser-assisted in situ keratomileusis (LASIK), one eye received PRX plus standard care and the fellow eye received standard care alone. PRX was administered four times daily from 2 weeks preoperatively to 6 months postoperatively. The primary outcome was the Schirmer test. The secondary outcomes included tear evaporation, corneal staining, conjunctival redness, corneal densitometry, and tear biomarkers, assessed up to 6 months. Ninety-two eyes (PRK, n = 48; LASIK, n = 44) were analyzed. The results showed that PRX did not produce sustained improvements in clinical outcomes. In PRK, PRX had no effect on tear biomarkers. In LASIK, Schirmer values improved at 1 month but did not persist. PRX was associated with transient reductions in inflammatory cytokines, including MCP-1 at 1 day, 1 week, and 1 month (effect ratios 0.56–0.62) and IL-8 at 1 week (0.41 [0.18–0.92]), along with increased NGF at 1 month (2.12 [1.19–3.78]). Overall, adjunctive PRX did not provide sustained benefit in the primary clinical outcome but was associated with transient changes in inflammatory tear biomarkers, primarily after LASIK, suggesting potential biological activity. However, short-term inflammatory modulation in selected contexts warrants further investigation. No treatment-related adverse events were observed.

Source: Scientific Reports

DOI: 10.1038/s41598-026-76236-y

Authors: Phit Upaphong, Nattayaporn Apaijai, Napaporn Tananuvat, Winai Chaidaroon, Nipon Chattipakorn, Siriporn C. Chattipakorn

Institutions: Chiang Mai University, Office of the Royal Society

Language: English

Topic: Ocular Surface and Contact Lens

Subfield: Ophthalmology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $2,690