Abstract：
Dry eye disease (DED) is a highly prevalent and debilitating condition. Hyaluronic acid (HA) is a naturally occurring glycosaminoglycan that has a long history as a safe and effective DED treatment. HA is frequently used as a comparator when assessing other topical DED treatments. This study aims to summarise and critically evaluate the literature describing all isolated active ingredients that have been directly compared with HA in the treatment of DED. A literature search was conducted in Embase using Ovid on the 24th of August 2021 and in PubMed including MEDLINE on the 20th of September 2021. Twenty-three studies met the inclusion criteria, 21 of which were randomised controlled trials. Seventeen different ingredients representing six treatment categories were compared with HA treatment. Most measures showed no significant difference between treatments, suggesting either equivalency of treatments or that studies were underpowered. Only two ingredients were represented in more than two studies; carboxymethyl cellulose treatment appears equivalent to HA treatment, while Diquafosol treatment appears superior to HA treatment. Drop-frequency varied from one to eight drops daily. No single study explained the choice of drop frequency. Nine studies used a HA concentration of 0.1% which may be below therapeutic levels. Nine studies reported using preserved formulations, six of them with differences in preservatives between the compared groups. Thirteen studies were financially linked to industry. No major complications were reported. Studies were not designed to find differences in treatment effects for different types or severities of DED. HA is a good comparator treatment when assessing other DED treatments, although consensus after decades of use is still lacking for best choice of concentration, molecular weight and drop tonicity. Well-designed studies are needed to determine an evidence-based standard for HA treatment to be used as comparator.
摘要：
干眼症（DED）是一种非常普遍和衰弱的疾病。透明质酸（HA）是一种天然存在的糖胺聚糖，作为一种安全有效的DED治疗方法具有悠久的历史。当评估其他局部DED治疗时，HA经常用作比较器。本研究旨在总结和严格评估描述在DED治疗中与HA直接比较的所有分离活性成分的文献。在2021年8月24日使用Ovid在Embase进行了文献检索，在2021年9月20日在PubMed包括MEDLINE进行了文献检索。23项研究符合纳入标准,其中21项为随机对照试验。将代表六个处理类别的17种不同成分与HA处理进行比较。大多数措施显示治疗之间没有显着差异，提示治疗的等效性或研究的功效不足。在两项以上的研究中只代表了两种成分；羧甲基纤维素处理似乎等同于HA处理，而Diquafosol治疗似乎优于HA治疗。滴落频率从每天一到八滴不等。没有一项研究解释了滴落频率的选择。九项研究使用的HA浓度为0.1%，可能低于治疗水平。九项研究报告使用保存的配方，其中6种防腐剂在比较组间存在差异。13项研究在财务上与行业相关。无重大并发症报告。研究并未旨在发现不同类型或严重程度的DED的治疗效果差异。在评估其他DED治疗时，HA是一个很好的比较治疗方法，尽管经过数十年的使用，仍然缺乏最佳浓度选择的共识，分子量和液滴张力。需要精心设计的研究来确定基于证据的HA治疗标准作为比较。
