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A. Behrens, A. Pirouzmanesh, T.I. Almeda, T.B. T. Nguyen, M. Mansoori, O.D. Schein, P.J. McDonnell; Dysfunctional Tear Syndrome Therapy: An Evidence–Based Review . Invest. Ophthalmol. Vis. Sci. 2004;45(13):3459.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: To evaluate the findings on published trials about therapeutic alternatives for the treatment of Dysfunctional Tear Syndrome (DTS). Methods: A total of 1953 citations potentially relevant to DTS were extracted from three databases: Medline, Cochrane Library and clinicaltrials.gov. Of these, 175 were unique and therefore included in the analysis. After a preliminary evaluation of this group, a total of 47 manuscripts were selected as true randomized clinical trials, and were chosen for our study. Due to the heterogeneity of the collected data, a meta–analysis approach was found not to be adequate. Reports were then individually evaluated and ranked. Quality assessment was performed according to Cochrane Reviewers Handbook 4.2.0. Evidence supporting different treatments for DTS was classified in good, fair, and insufficient. Results: There was good evidence on the efficacy of topical cyclosporine A, sodium hyaluronate, and silicone punctal plugs, to minimize symptoms of DTS. There was fair evidence for diquafosol, polyacrilic acid, polyvinyl alcohol, corticosteroids, and trehalose. Insufficient evidence was collected for autologous serum, castor oil, oral antioxidant therapy, oral linoleic/gamma–linolenic acid therapy, oral pilocarpine, and acupuncture.Conclusions: Despite the large number of trials on treatment for DTS, limted evidence exists to support the recommendation of some pharmaceutical agents. Clinical research should be standardized in this disease to allow meta–analytic evaluation. Overall, newer drugs have a more substantiated support in the literature, and therefore are more likely to have appropriate evidence reported.
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