Yan Wen1, Xiaocheng Zhang1, Maosheng Chen1, Dengmei Han2. 1. Department of Ophthalmology, Chongqing Aier Eye Hospital, Chongqing 400000, China. 2. Department of Ophthalmology, Chongqing Aier Mega Eye Hospital, Chongqing 400060, China. dengtaid@126.com.
Abstract
BACKGROUND: The incidence of dry eye is high after a cataract surgery. However, the clinical efficacy of sodium hyaluronate combined with conventional eye drops for dry eye after cataract surgery remains unclear. The currently available studies were based on small sample sizes, and no systematic review on this topic has been conducted. Thus, a meta-analysis was performed to systematically and accurately evaluate the clinical value of sodium hyaluronate in the treatment of dry eye after cataract surgery. METHODS: English-language databases including PubMed, Cochrane, and Web of Science, and Chineselanguage databases including (CNKI), Wanfang Database, and CQVIP were systematically searched for relevant articles published up to December 31, 2019. The pooled effect size of qualitative data was evaluated with relative risk (RR) and 95% confidence interval (CI), and the overall effect of the quantitative data was estimated by using weighted mean difference (WMD) or standard mean difference (SMD) and 95% CI. Randomized controlled clinical trials concerning the use of sodium hyaluronate combined with conventional treatment for dry eye after cataract surgery were included. The quality of the included literature was evaluated by RevMan5.3 software, and the rest of the statistical data were analyzed using the "meta" package of the R3.5.1 software. RESULTS: A total of 24 articles including 2,177 eyes (1,088 eyes in the combination group and 1089 eyes in the control group) were included. Twelve articles reported the total effective rate after 1 month of treatment (I2 =71%), and the random effects model was used to estimate RR. The total effective rate in the combination group was 1.33 times that of the control group (95% CI: 1.21, 1.47). Ten articles reported the dry eye symptom score after 1 month of treatment (I2 =92%). The SMD was estimated using the random effects model. The dry eye symptom score in the combination group was significantly lower than that in the control group, with an SMD of -2.98 (95% CI: -3.69, -2.27). Seventeen articles reported the tear film break-up time (BUT) after 1 month of treatment. As shown in the random effects model, BUT was significantly longer in the combination group than in the control group, with an MD of 2.06 (95% CI: 1.63, 2.49). Sixteen articles described the scores of a fluorescein (FL) eye stain test after 1 month of treatment. As shown in the random effects model, FL score was significantly lower in the combination group than in the control group, with an SMD of -2.52 (95% CI: -3.23, -1.81). Eight articles reported the results of Schirmer I test (SIt) after 1 month of treatment. As estimated by the random effects model, the wetting length in SIt was significantly higher in the combination group than in the control group, with an MD of 1.50 (95% CI: 0.53, 2.48). In the elderly population, BUT was significantly higher in the combined group than in the control group, with an MD of 2.97 (95%CI: 2.47, 3.47); however, the FL score and SIt showed no such significant difference. CONCLUSIONS: For the patients with dry eye after cataract surgery, sodium hyaluronate on the basis of conventional anti-inflammatory treatment is highly effective as it can improve the dry eye symptom score and the results of 3 tests for dry eye. However, high-quality studies are warranted to further investigate the safety of sodium hyaluronate.
BACKGROUND: The incidence of dry eye is high after a cataract surgery. However, the clinical efficacy of sodium hyaluronate combined with conventional eye drops for dry eye after cataract surgery remains unclear. The currently available studies were based on small sample sizes, and no systematic review on this topic has been conducted. Thus, a meta-analysis was performed to systematically and accurately evaluate the clinical value of sodium hyaluronate in the treatment of dry eye after cataract surgery. METHODS: English-language databases including PubMed, Cochrane, and Web of Science, and Chineselanguage databases including (CNKI), Wanfang Database, and CQVIP were systematically searched for relevant articles published up to December 31, 2019. The pooled effect size of qualitative data was evaluated with relative risk (RR) and 95% confidence interval (CI), and the overall effect of the quantitative data was estimated by using weighted mean difference (WMD) or standard mean difference (SMD) and 95% CI. Randomized controlled clinical trials concerning the use of sodium hyaluronate combined with conventional treatment for dry eye after cataract surgery were included. The quality of the included literature was evaluated by RevMan5.3 software, and the rest of the statistical data were analyzed using the "meta" package of the R3.5.1 software. RESULTS: A total of 24 articles including 2,177 eyes (1,088 eyes in the combination group and 1089 eyes in the control group) were included. Twelve articles reported the total effective rate after 1 month of treatment (I2 =71%), and the random effects model was used to estimate RR. The total effective rate in the combination group was 1.33 times that of the control group (95% CI: 1.21, 1.47). Ten articles reported the dry eye symptom score after 1 month of treatment (I2 =92%). The SMD was estimated using the random effects model. The dry eye symptom score in the combination group was significantly lower than that in the control group, with an SMD of -2.98 (95% CI: -3.69, -2.27). Seventeen articles reported the tear film break-up time (BUT) after 1 month of treatment. As shown in the random effects model, BUT was significantly longer in the combination group than in the control group, with an MD of 2.06 (95% CI: 1.63, 2.49). Sixteen articles described the scores of a fluorescein (FL) eye stain test after 1 month of treatment. As shown in the random effects model, FL score was significantly lower in the combination group than in the control group, with an SMD of -2.52 (95% CI: -3.23, -1.81). Eight articles reported the results of Schirmer I test (SIt) after 1 month of treatment. As estimated by the random effects model, the wetting length in SIt was significantly higher in the combination group than in the control group, with an MD of 1.50 (95% CI: 0.53, 2.48). In the elderly population, BUT was significantly higher in the combined group than in the control group, with an MD of 2.97 (95%CI: 2.47, 3.47); however, the FL score and SIt showed no such significant difference. CONCLUSIONS: For the patients with dry eye after cataract surgery, sodium hyaluronate on the basis of conventional anti-inflammatory treatment is highly effective as it can improve the dry eye symptom score and the results of 3 tests for dry eye. However, high-quality studies are warranted to further investigate the safety of sodium hyaluronate.