Hu Jindong, Ju Mohan, Shi Yongjun, Liu Xinquan, Zhu Yongbao
Department of Integrative Medicine, Huashan Hospital, Fudan University, Shanghai, China.
Department of Integrative Medicine, Baoshan Campus of Huashan Hospital, Fudan University, Shanghai, China.
Indian J Ophthalmol. 2024 May 1;72(Suppl 3):S381-S392. doi: 10.4103/IJO.IJO_2147_23. Epub 2024 Mar 8.
This study aimed to investigate the efficacy and safety of trigeminal parasympathetic pathway (TPP) stimulation in the treatment of dry eye. A comprehensive search for randomized clinical trials was performed in seven databases (MEDLINE, Embase, CENTRAL, etc.) up to 28 February 2023. After screening the suitable studies, the data were extracted and transformed as necessary. Data synthesis and analysis were performed using Review Manager 5.4, and the risk of bias and quality of evidence were evaluated with the recommended tools. Fourteen studies enrolling 1714 patients with two methods (electrical and chemical) of TPP stimulation were included. Overall findings indicate that TPP stimulation was effective in reducing subjective symptom score (standardized mean difference [SMD], -0.45; 95% confidence interval [CI], -0.63 to -0.28), corneal fluorescence staining (mean difference [MD], -0.78; 95% CI, -1.39 to -0.18), goblet cell area (MD, -32.10; 95% CI, -54.58 to -9.62) and perimeter (MD, -5.90; 95% CI, -10.27 to -1.53), and increasing Schirmer's test score (SMD, 0.98; 95% CI, 0.65 to 1.31) and tear film break-up time (SMD, 0.57; 95% CI, 0.19 to 0.95). Compared to inactive or low-activity stimulation controls, it has a higher incidence of adverse events. Therefore, TPP stimulation may be an effective treatment for dry eye, whether electrical or chemical. Adverse events are relatively mild and tolerable. Due to the high heterogeneity and low level of evidence, the current conclusions require to be further verified.
本研究旨在探讨三叉神经副交感神经通路（TPP）刺激治疗干眼症的疗效和安全性。截至2023年2月28日，在七个数据库（MEDLINE、Embase、CENTRAL等）中对随机临床试验进行了全面检索。筛选出合适的研究后，提取数据并在必要时进行转换。使用Review Manager 5.4进行数据合成和分析，并使用推荐工具评估偏倚风险和证据质量。纳入了14项研究，共1714例采用两种TPP刺激方法（电刺激和化学刺激）的干眼症患者。总体研究结果表明，TPP刺激在降低主观症状评分（标准化均数差[SMD]，-0.45；95%置信区间[CI]，-0.63至-0.28）、角膜荧光素染色（均数差[MD]，-0.78；95%CI，-1.39至-0.18）、杯状细胞面积（MD，-32.10；95%CI，-54.58至-9.62）和周长（MD，-5.90；95%CI，-10.27至-1.53），以及提高泪液分泌试验评分（SMD，0.98；95%CI，0.65至1.31）和泪膜破裂时间（SMD，0.57；95%CI，0.19至0.95）方面有效。与无活性或低活性刺激对照组相比，其不良事件发生率更高。因此，无论电刺激还是化学刺激，TPP刺激可能是治疗干眼症的有效方法。不良事件相对较轻且可耐受。由于异质性高和证据水平低，目前的结论需要进一步验证。
