Rasmussen Marie Louise Roed, Schou Marianne Guldager, Bach-Holm Daniella, Heegaard Steffen, Jørgensen Christel Asserina Bjerregaard, Kessel Line, Wiencke Anne Katrine, Subhi Yousif
Department of Ophthalmology, Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Ophthalmol. 2022 Feb;100(1):35-44. doi: 10.1111/aos.14858. Epub 2021 Mar 28.
To systematically review the literature on the treatment of vernal keratoconjunctivitis (VKC) in children and young adults and conduct comparative efficacy analysis on clinical signs and symptoms using network meta-analyses.
We systematically searched the databases PubMed/MEDLINE, EMBASE, Cochrane Central and Web of Science on 21 October 2019 for randomized controlled trials (RCT). Studies considered had patients with VKC < 20 years of age randomized into either intervention (any medical intervention) or comparator (active treatment, placebo treatment or non-treatment control), where pre-defined outcomes (data from ≥2 weeks and as close as possible to 2 months) of symptoms (itching, tearing, photophobia and foreign body sensation) and signs (hyperaemia, punctate keratitis, Horner-Trantas dots and macropapillae) were reported. Risk of bias within studies was evaluated using the Cochrane risk of bias tool. Comparisons were made using network meta-analyses.
We identified 39 studies with data on 2046 individuals. Twenty-three studies were eligible for quantitative analyses. None were systemic therapy. Temporal trend analysis showed that an initial focus on topical mast cell stabilizers turned to a focus on calcineurin inhibitors and a more diverse variety of pharmacological strategies. Studies varied in population, treatment duration and quality. The quantitative analysis revealed that efficacy of different therapies differed substantially across important clinical signs and symptoms, but there was a general trend of superior efficacy when using topical corticosteroids with stronger efficacy of the more potent corticosteroids.
We provide an overview of RCTs comparing the efficacy of treatments for VKC in children and young adults, which we find differs across symptoms and signs. Overall, we saw a general trend of superior efficacy with topical corticosteroids. However, our findings highlight the need for better studies, consensus on core outcomes and potential for individualized therapy.
系统回顾关于儿童和青年春季角结膜炎（VKC）治疗的文献，并使用网状Meta分析对临床体征和症状进行比较疗效分析。
2019年10月21日，我们系统检索了PubMed/MEDLINE、EMBASE、Cochrane Central和Web of Science数据库中的随机对照试验（RCT）。纳入的研究为年龄小于20岁的VKC患者，随机分为干预组（任何医学干预）或对照组（积极治疗、安慰剂治疗或非治疗对照），其中报告了预定义的结局（≥2周且尽可能接近2个月的数据），包括症状（瘙痒、流泪、畏光和异物感）和体征（充血、点状角膜炎、Horner-Trantas点和巨乳头）。使用Cochrane偏倚风险工具评估研究中的偏倚风险。使用网状Meta分析进行比较。
我们确定了39项涉及2046名个体数据的研究。23项研究符合定量分析要求。均非全身治疗。时间趋势分析表明，最初对焦于局部肥大细胞稳定剂，后来转向关注钙调神经磷酸酶抑制剂和更多样化的药理策略。研究在人群、治疗持续时间和质量方面存在差异。定量分析显示，不同疗法在重要临床体征和症状方面的疗效差异很大，但使用局部糖皮质激素时总体有疗效更佳的趋势，且更强效的糖皮质激素疗效更强。
我们概述了比较儿童和青年VKC治疗疗效的RCT，发现不同症状和体征的疗效不同。总体而言，我们看到局部糖皮质激素有疗效更佳的总体趋势。然而，我们的研究结果凸显了开展更好研究、就核心结局达成共识以及个体化治疗潜力的必要性。
