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Topical cyclosporine A in the treatment of dry eye: A systematic review and meta-analysis

机译：外用环孢素A治疗干眼症：系统评价和荟萃分析

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PURPOSE: Cyclosporine A (CsA) is considered a potentially effective treatment for dry eye syndrome (DES), which is now one of the most common ocular problems whose exact mechanism is unknown. Because randomized controlled trials (RCTs) reported to date have shown varying results in the efficacy and safety of CsA in different types of DES, we conducted a systematic review and meta-analysis of RCTs on CsA versus placebo in treating DES to evaluate the treatment efficacy and safety of CsA. METHODS: We searched for RCTs published after 1990, in MEDLINE, EMBASE, the Cochrane library, and ClinicalTrials.gov. The RCTs that were included compared topical CsA and placebo for DES treatment by evaluating scores of ocular surface disease index, tear break-up time, or Schirmer test. Cochrane risk of bias tool was used for assessing the risk of bias. RESULTS: We included 12 RCTs involving 3034 eyes of 1660 participants. We observed statistically significant improvements on scores of break-up time (standardized mean difference [SMD], 0.80; 95% confidence interval [CI], 0.13-1.46; I2 = 95%) and scores of Schirmer test with anesthesia (SMD, 0.78; 95% CI, 0.09-1.46; I2 = 97%) after treatment with topical CsA. Scores of ocular surface disease index (SMD, 0.77; 95% CI, -1.05 to 2.58; I2 = 98%) and scores of Schirmer test without anesthesia (SMD, 0.08; 95% CI, -0.11 to 0.27; I2 = 0%) were not improved. Adverse events (odds ratio [OR], 1.61; 95% CI, 1.28-2.02; I2 = 21%) were observed. CONCLUSIONS: Topical CsA could be an effective treatment for DES, especially for DES associated with conjunctival injury. Further RCTs with larger sample sizes for different clinical types of DES are warranted to determine the efficacy and limitation for different clinical types of DES.
机译：目的：环孢素A（CsA）被认为是干眼症候群（DES）的一种潜在有效治疗方法，该病目前是最常见的眼病之一，其确切机制尚不清楚。由于迄今为止报道的随机对照试验（RCT）在不同类型的DES中显示了CsA疗效和安全性的不同结果，因此我们对CsA与安慰剂治疗RCS进行了系统的回顾和荟萃分析，以评估DES的治疗效果和CsA的安全性。方法：我们搜索了1990年后发布的RCT，它们位于MEDLINE，EMBASE，Cochrane库和ClinicalTrials.gov中。通过评估眼表疾病指数，泪液破裂时间或Schirmer检验的分数，纳入的RCT比较了局部CsA和安慰剂进行DES治疗的情况。 Cochrane偏倚风险工具用于评估偏倚风险。结果：我们纳入了12个RCT，涉及1660名参与者的3034眼。我们观察到分手时间评分（标准平均差[SMD]为0.80; 95％置信区间[CI]为0.13-1.46; I2 = 95％）和Schirmer麻醉评分（SMD为0.78）有统计学意义的改善; 95％CI，0.09-1.46; I2 = 97％）。眼表疾病指数得分（SMD，0.77; 95％CI，-1.05至2.58; I2 = 98％）和无麻醉的Schirmer测试得分（SMD，0.08; 95％CI，-0.11至0.27; I2 = 0％ ）没有改善。观察到不良事件（赔率[OR]为1.61; 95％CI为1.28-2.02; I2 = 21％）。结论：局部CsA可能是治疗DES的有效方法，尤其是结膜损伤相关的DES。对于不同临床类型的DES，有更多的具有较大样本量的RCT保证确定不同临床类型的DES的功效和局限性。

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