Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome A Report by the American Academy of Ophthalmology
Safety and Efficacy of Lacrimal Drainage System Plugs for Dry Eye Syndrome A Report by the American Academy of Ophthalmology
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DOI：
10.1016/j.ophtha.2015.04.034
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发表时间：
2015-08-01
期刊：
影响因子：
13.7
通讯作者：
Mawn, Louise A.
中科院分区：
文献类型：
--
作者：
Marcet, Marcus M.;Shtein, Roni M.;Mawn, Louise A.
目的：回顾已发表的文献，评估泪道引流系统塞插入术治疗成人干眼症的有效性和安全性。方法：PubMed和科克伦图书馆数据库的文献检索最后一次进行于2015年3月9日，没有日期限制，仅限于英文摘要。检索到309篇唯一引文。主要作者审查了标题和摘要。入选标准规定了提供至少25例患者干眼塞治疗的原始数据的报告。53项潜在相关性研究被分配进行全文审查。符合纳入标准的27项研究由专家组进行数据提取。摘要数据包括研究特征、患者特征、塞类型、插入技术、治疗反应和安全性信息。所有的研究都是观察性的，并由一个方法学家评定为II级或III级evidence.Results：塞子包括泪点，管内，溶解型。15项研究报告了干眼症状、眼表状态、人工泪液使用、接触透镜舒适度和泪液破裂时间的改善指标。25项研究纳入了安全性数据。干眼患者置入眼塞后症状改善>= 50%，眼表健康改善，人工泪液使用减少，接触透镜舒适度改善。栓塞引起的严重并发症很少发生。泪点塞脱落是最常见的问题，平均发生在40%的患者中。总体而言，在所有类型的塞子中，约9%的患者发生溢泪，10%的患者因塞子刺激而需要取出。泪小管炎是泪小管内塞最常报告的问题，约8%的患者发生。其他并发症的报告，平均不到4%的患者，包括流泪，不适，化脓性肉芽肿，和dacryocystitis.Conclusions：在这些研究中的II级和III级证据的基础上，塞改善的体征和症状的中度干眼症，局部润滑没有改善，他们是耐受性良好。没有I级研究描述泪道引流系统塞的有效性或安全性。(C)2015年，美国眼科学会。
Objective: To review the published literature assessing the efficacy and safety of lacrimal drainage system plug insertion for dry eye in adults.Methods: Literature searches of the PubMed and Cochrane Library databases were last conducted on March 9, 2015, without date restrictions and were limited to English language abstracts. The searches retrieved 309 unique citations. The primary authors reviewed the titles and abstracts. Inclusion criteria specified reports that provided original data on plugs for the treatment of dry eyes in at least 25 patients. Fifty-three studies of potential relevance were assigned to full-text review. The 27 studies that met the inclusion criteria underwent data abstraction by the panels. Abstracted data included study characteristics, patient characteristics, plug type, insertion technique, treatment response, and safety information. All studies were observational and rated by a methodologist as level II or III evidence.Results: The plugs included punctal, intracanalicular, and dissolving types. Fifteen studies reported metrics of improvement in dry eye symptoms, ocular-surface status, artificial tear use, contact lens comfort, and tear break-up time. Twenty-five studies included safety data. Plug placement resulted in >= 50% improvement of symptoms, improvement in ocular-surface health, reduction in artificial tear use, and improved contact lens comfort in patients with dry eye. Serious complications from plugs were infrequent. Plug loss was the most commonly reported problem with punctal plugs, occurring on average in 40% of patients. Overall, among all plug types, approximately 9% of patients experienced epiphora and 10% required removal because of irritation from the plugs. Canaliculitis was the most commonly reported problem for intracanalicular plugs and occurred in approximately 8% of patients. Other complications were reported in less than 4% of patients on average and included tearing, discomfort, pyogenic granuloma, and dacryocystitis.Conclusions: On the basis of level II and III evidence in these studies, plugs improve the signs and symptoms of moderate dry eye that are not improved with topical lubrication, and they are well tolerated. There are no level I studies that describe the efficacy or safety of lacrimal drainage system plugs. (C) 2015 by the American Academy of Ophthalmology.