Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
Br J Ophthalmol. 2019 Mar;103(3):301-306. doi: 10.1136/bjophthalmol-2018-313267. Epub 2018 Oct 18.
Dry eye disease is a disorder of the tear film associated with ocular signs and symptoms. Punctal occlusion aids the preservation of natural tears. We conducted a Cochrane systematic review to assess the effectiveness of punctal plugs for managing dry eye. Randomised and quasi-randomised trials were included. The primary outcome was symptomatic improvement (SI) at 2-12 months. Nine databases were searched with no date or language restrictions. Two authors assessed trial quality and extracted data. Summary risk ratios and mean differences were calculated. Ten trials were included. In two trials of punctal plugs versus observation, there was less dryness with punctal plugs. The mean difference (MD) in the dry eye symptom score at 2 months was -28.20 points (95% CI -33.61 to -22.79, range 0 to 105, one trial). Three trials compared punctal plugs with artificial tears. In a pooled analysis of two trials, punctal plug participants reported more SI at 3 months than artificial tear participants (MD -4.20 points, 95% CI -5.87 to -2.53, scales varied from 0 to 6). In the remaining five trials comparing punctal plug placement, acrylic and silicone plugs, or comparing plugs with cyclosporine or pilocarpine, none of the investigators reported a clinically or statistically meaningful difference in symptomatic improvement at 2-12 months. The effectiveness of punctal plugs for treating dry eye symptoms and common signs are inconclusive. Heterogeneity in the type of punctal plug, type and severity of dry eye being treated, and trial methodology confounds the ability to make decisive statements regarding the effectiveness of punctal plugs.
干眼症是一种与眼表体征和症状相关的泪膜紊乱。泪点封闭有助于保存天然泪液。我们进行了一项 Cochrane 系统评价，以评估泪点塞治疗干眼症的效果。纳入了随机和准随机试验。主要结局是 2-12 个月时的症状改善（SI）。对 9 个数据库进行了检索，没有时间或语言限制。两名作者评估了试验质量并提取了数据。计算了汇总风险比和平均差异。纳入了 10 项试验。在 2 项泪点塞与观察的试验中，泪点塞的干燥感较轻。2 个月时干眼症状评分的平均差异（MD）为-28.20 分（95%CI -33.61 至-22.79，范围 0 至 105，一项试验）。有 3 项试验比较了泪点塞与人工泪液。在两项试验的汇总分析中，泪点塞组参与者在 3 个月时报告的 SI 比人工泪液组多（MD-4.20 分，95%CI -5.87 至-2.53，量表范围为 0 至 6）。在其余 5 项比较泪点塞放置、丙烯酸和硅胶塞、或比较塞与环孢素或毛果芸香碱的试验中，没有一项研究报告在 2-12 个月时症状改善有临床或统计学意义的差异。泪点塞治疗干眼症状和常见体征的效果尚无定论。泪点塞的类型、治疗的干眼类型和严重程度以及试验方法的异质性，使得我们无法对泪点塞的有效性做出明确的结论。
