Pang Shin-Pin, Chen Yu-Tse, Tam Ka-Wai, Lin I-Chan, Loh El-Wui
School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.
Cornea. 2019 Jun;38(6):690-697. doi: 10.1097/ICO.0000000000001907.
Meibomian gland dysfunction is the main cause of dry eye disease (DED) and is traditionally managed using warm compress treatment (WCT). Vectored thermal pulsation treatment (VTPT) is a novel method for treating DED.
We conducted a systematic review and meta-analysis of randomized controlled trials that compared the efficacy of VTPT and WCT in treating DED. The primary outcome was the gland function. The secondary outcomes were the tear breakup time, Schirmer test, tear osmolarity, lipid layer thickness, Standard Patient Evaluation for Eye Dryness, and the improvement of subjective symptoms as assessed by using the Ocular Surface Disease Index. PubMed, Embase, Cochrane Library, and ClinicalTrials.gov registries were searched for studies published before July 2018.
This study consisted of 4 trials with 385 patients. Significantly greater improvement was observed in meibomian gland function [mean difference (MD): 2.19 (95% confidence interval (CI), 0.95, 3.43)], tear breakup time [MD: 1.08 (95% CI, 0.06, 2.10)], and Standard Patient Evaluation for Eye Dryness [MD: -2.76 (95% CI, -4.22, -1.30)] at 2 to 4 weeks in the VTPT group than in the WCT group. A significantly greater decrease in Ocular Surface Disease Index was observed at 2 to 4 weeks [MD: -8.61 (95% CI, -13.62, -3.61)] and 3 months [MD: -6.92 (95% CI, -11.95, -1.89)] in the VTPT group than in the WCT group.
A single 12-minute VTPT was more efficacious than traditional WCT in treating DED either in objective or subjective measurements. We recommended choosing an appropriate treatment after shared decision-making.
睑板腺功能障碍是干眼疾病（DED）的主要病因，传统上采用热敷治疗（WCT）。矢量热脉动治疗（VTPT）是一种治疗DED的新方法。
我们对比较VTPT和WCT治疗DED疗效的随机对照试验进行了系统评价和荟萃分析。主要结局是腺体功能。次要结局包括泪膜破裂时间、泪液分泌试验、泪液渗透压、脂质层厚度、干眼标准患者评估以及使用眼表疾病指数评估的主观症状改善情况。检索了PubMed、Embase、Cochrane图书馆和ClinicalTrials.gov注册库中2018年7月之前发表的研究。
本研究包括4项试验，共385例患者。与WCT组相比，VTPT组在2至4周时睑板腺功能[平均差（MD）：2.19（95%置信区间（CI），0.95，3.43）]、泪膜破裂时间[MD：1.08（95%CI，0.06，2.10）]和干眼标准患者评估[MD：-2.76（95%CI，-4.22，-1.30）]有更显著的改善。与WCT组相比，VTPT组在2至4周[MD：-8.61（95%CI，-13.62，-3.61）]和3个月[MD：-6.92（95%CI，-11.95，-1.89）]时眼表疾病指数有更显著的降低。
单次12分钟的VTPT在客观或主观测量方面治疗DED比传统WCT更有效。我们建议在共同决策后选择合适的治疗方法。
