背景:流行性角膜结膜炎(EKC)是一种高度传染性的感染性眼病,已在世界范围内广泛传播。糖皮质激素(OPGs)的眼科制剂是EKC的支持疗法;然而,他们仍然有争议。
方法:我们进行了系统综述和荟萃分析,以评估OPG在EKC患者中的疗效和安全性。在PubMed进行了电子搜索,Embase,Cochrane图书馆,ClinicalTrials.gov,中国国民知识互联网(CNKI),和万方数据库从成立到2022年8月25日。我们纳入并分析了随机对照试验(RCT)和队列研究,这些研究将OPG与其他阳性药物或安慰剂在EKC患者中进行了比较。
结果:6项研究(5项RCT和1项回顾性队列)纳入分析,涉及286例患者。与人工泪液相比,OPGs可以在流行性角膜结膜炎(AEKC)的急性期更快地缓解眼部症状。当OPG使用7天时,AEKC中角膜上皮下浸润(SEIs)的发生率没有显着差异,但在21天和28天有实质性的差异。在流行性角膜结膜炎(CEKC)的慢性期,与免疫抑制剂相比,OPGs治疗6个月时SEIs完全消除率无显著差异[RR=1.07,95CI(0.71,1.61),p=0.75],以及6个月后SEIs的复发率[RR=2.05,95CI(0.82,5.12),P=0.13]。与免疫抑制剂相比,OPGs在6个月时显着增加眼内压(IOP)[MD=-1.13,95CI(-1.97,-0.30),P=0.007]。OPGs和免疫抑制剂之间由于药物不耐受而停止治疗没有显着差异[RR=0.69,95CI(0.16,2.94),p=0.62]。
结论:OPGs可以缓解眼部症状,降低AEKC中SEI的发生率,而不推荐在CEKC治疗。需要更多高质量的临床证据来证实我们的发现。
Epidemic
keratoconjunctivitis (EKC) is a highly contagious infectious ocular disease that has been widespread worldwide. Ophthalmic preparations of glucocorticoids (OPGs) are the supportive therapies for EKC; however, they are still controversial.
We performed a systematic
review and meta-analysis to evaluate the efficacy and safety of OPGs in patients with EKC. Electronic searches were conducted in PubMed, Embase, the Cochrane Library, ClinicalTrials.gov, China National Knowledge Internet (CNKI), and Wanfang Database from inception to 25 Aug 2022. We included and analyzed randomized controlled trials (RCTs) and cohort studies that compared OPGs to other positive drugs or placebo in patients with EKC.
Six studies (five RCTs and one retrospective cohort) involving 286 patients were included in the analysis. Compared with artificial tears, OPGs could relieve ocular symptoms faster in the acute phase of epidemic
keratoconjunctivitis (AEKC). There was no significant difference in the incidence of corneal subepithelial infiltrates (SEIs) in AEKC when OPGs were used for 7 days, but there was a substantial difference for 21 and 28 days. In the chronic phase of epidemic
keratoconjunctivitis (CEKC), there was no significant difference in the rate of complete elimination of SEIs at 6 months of OPGs treatment compared with immunosuppressants [RR = 1.07,95%CI (0.71,1.61), p = 0.75], as well as in the recurrence rate of SEIs after 6 months [RR = 2.05,95%CI (0.82,5.12), P = 0.13]. OPGs significantly increased intraocular pressure (IOP) at 6 months compared with immunosuppressants [MD = - 1.13,95%CI (- 1.97, - 0.30), P = 0.007]. There was no significant difference in cessation of therapy due to drug intolerance between OPGs and immunosuppressants [RR = 0.69,95%CI (0.16,2.94), p = 0.62].
OPGs might relieve ocular symptoms and reduce the incidence of SEIs in AEKC, whereas not recommended the therapy in CEKC. More high-quality clinical evidence is required to confirm our findings.