Topical corticosteroids for dry eye

Liu, Su-Hsun; Saldanha, Ian J.; Abraham, Alison G.; Rittiphairoj, Thanitsara; Hauswirth, Scott G; Gregory, Darren G.; Ifantides, Cristos; Li, Tianjing

doi:10.1002/14651858.cd015070.pub2

Cited by 12 publications

(16 citation statements)

References 73 publications

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“…Our search yielded 138 unique reports, from which we included 71 eligible reviews for reliability assessment (eFigure in the Supplement). We judged 26 of 71 (37%) reviews to be reliable . Reasons for unreliability are shown in eTable 4 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

“…Summaries of reliable systematic reviews are described in Table 2 . Data integration tables for each systematic review are outlined in eTable 6 to eTable 31 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

“…Data integration tables for each systematic review are outlined in eTable 6 to eTable 31 in the Supplement. Table 3 outlines the main findings of the critical outcomes and adverse effects for all dry eye interventions . Detailed narrative synthesis of evidence for interventions recommended by the 2018 AAO PPP on dry eye are provided in the eResults in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

“…Among prescription-only topical therapies, topical cyclosporine A and topical secretagogues may improve dry eye symptoms, and topical corticosteroids are probably effective . Topical corticosteroids with or without tobramycin probably improve dry eye symptoms and corneal fluorescein staining slightly compared with lubricants or tobramycin alone (certainty: moderate) . Topical corticosteroids may increase the risk of elevated intraocular pressure (MedDRA: intraocular pressure increased) at short-term follow-up (certainty: very low) .…”

Section: Resultsmentioning

confidence: 99%

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Interventions for Dry Eye

McCann,

Kruoch,

Lopez

et al. 2024

JAMA Ophthalmol

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ImportanceDry eye is a common ocular disease that can have substantial morbidity. Systematic reviews provide evidence for dry eye interventions and can be useful for patients, clinicians, and clinical guideline developers. Overviews of reviews use explicit and systematic methods to synthesize findings from multiple systematic reviews, but currently, there are no overviews of systematic reviews investigating interventions for dry eye.ObjectiveTo summarize the results of reliable systematic reviews of dry eye interventions and to highlight the evidence gaps identified.Evidence ReviewWe searched the Cochrane Eyes and Vision US satellite database and included reliable systematic reviews evaluating dry eye interventions published from 2016 to 2022. We reported the proportion of systematic reviews that were reliable with reasons for unreliability. Critical and important outcomes from reliable systematic reviews were extracted and verified. Critical outcomes included dry eye–related patient-reported outcome measures. Results were synthesized from reliable systematic reviews to provide summaries of evidence for each intervention. Evidence for each intervention was defined as conclusive or inconclusive depending on whether high-certainty evidence across systematic reviews was available according to Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria and whether findings reached statistical or clinical significance. Recommendations were made for further research.FindingsWithin the Cochrane Eyes and Vision US satellite database, 138 potentially relevant systematic reviews were identified, 71 were considered eligible, and 26 (37%) were assessed as reliable. Among reliable systematic reviews, no conclusive evidence was identified for any dry eye intervention. Inconclusive evidence suggested that environmental modifications, dietary modifications, artificial tears and lubricants, punctal occlusion, intense pulsed light therapy, vectored thermal pulsation therapy (Lipiflow), topical corticosteroids, topical cyclosporine A, topical secretagogues, and autologous serum may be effective. Only unreliable systematic reviews evaluated lifitegrast, oral antibiotics, and moisture chamber devices.Conclusions and RelevanceThis overview of systematic reviews found some evidence that dry eye interventions may be effective, but no conclusive evidence was available. The conduct and reporting of most systematic reviews for dry eye interventions warrant improvement, and reliable systematic reviews are needed to evaluate lifitegrast, oral antibiotics, and moisture chamber devices.

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Section: Resultsmentioning

confidence: 99%

“…Summaries of reliable systematic reviews are described in Table 2 . Data integration tables for each systematic review are outlined in eTable 6 to eTable 31 in the Supplement.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Interventions for Dry Eye

McCann,

Kruoch,

Lopez

et al. 2024

JAMA Ophthalmol

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“…Treatments for dry eye include artificial tears, topical cyclosporin A, topical steroids, punctal plugs, nutritional supplements, intense pulsed light, and others. The effectiveness and safety of individual treatments have been summarized in several Cochrane systematic reviews 16–20 . A commonality with all of the aforementioned treatments is that they do not reflect the composition of natural tears, which contain various lipids, carbohydrates, proteins, vitamins, and growth factors 21 .…”

mentioning

confidence: 99%

Autologous Serum Eye Drops for Dry Eye: Systematic Review

Quan

Leslie

2023

Optom Vis Sci

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Background Dry eye is a common condition with serious implications worldwide. The unique composition of autologous serum eye drops (AS) has been hypothesized as a possible treatment. Objectives To review the effectiveness and safety of AS. Data Sources We searched five databases and three registries up to September 30, 2022. Study Eligibility Randomized clinical trials (RCT) comparing AS with artificial tears, saline, or placebo for participants with dry eye. Study Appraisal and Synthesis Methods We adhered to Cochrane methods for study selection, data extraction, risk of bias assessment, and synthesis. We used the GRADE framework to evaluate the certainty of evidence. Results We included six RCTswith 116 participants. Four trials compared AS with artificial tears. We found low-certainty evidence that AS may improve symptoms (0-100 pain scale) after two weeks of treatment compared with saline (MD -12.00, 95% CI: -20.16 to -3.84; 1 RCT, 20 participants). Ocular surface outcomes (corneal staining, conjunctival staining, tear break-up time, Schirmer’s test) were inconclusive. Two trials compared AS with saline. Very low-certainty evidence suggested that Rose Bengal staining (0-9 scale) may be slightly improved after four weeks of treatment compared with saline (MD -0.60, 95% CI: -1.11 to -0.09; 35 eyes). None of the trials reported outcomes of corneal topography, conjunctival biopsy, quality of life, economic outcomes, or adverse events. Limitations We were unable to use all data due to unclear reporting. Conclusions The effectiveness of AS is uncertain based on current data. Symptoms improved slightly with AS compared with artificial tears for two weeks. Staining scores improved slightly with AS compared with saline, with no benefit identified for other measures. Implications of Key Findings High-quality, large trials enrolling diverse participants with varying severity are needed. A core outcome set would allow for evidence-based treatment decisions consistent with current knowledge and patient values.

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