No abstract

BackgroundPterygium is a common ocular surface disease. Recurrence is the greatest concern in the treatment of pterygium. Thus, a standardized and effective treatment modality with minimal risk for complications is needed for the management of pterygium. The aim of this systematic review and meta-analysis was to evaluate different tissue grafting options, including conjunctival autograft (CAG) with mitomycin C (MMC), CAG alone, and amniotic membrane transplantation (AMT), for the management of primary pterygium.MethodsWe searched the MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials databases for relevant studies. We included randomized controlled trials (RCTs) in which CAG + MMC and AMT were compared with surgical excision with CAG alone for the treatment of primary pterygium. The rates of recurrence and adverse events reported in the studies were also evaluated. Risk ratio (RR) was used to represent dichotomous outcomes. The data were pooled using the inverse variance weighting method. The quality of the evidence derived from the analysis was assessed using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Risk of bias was assessed using the revised Cochrane risk-of-bias tool for randomized trials.ResultsTwelve RCTs (n = 1144) were deemed eligible and included for analysis. Five RCTs had a low risk of bias, five had some concerns, and two had a high risk of bias. Subgroup analysis showed a statistically significant reduction in the rate of pterygium recurrence after CAG + MMC (RR = 0.12; 95% confidence interval [CI], 0.02–0.63). This outcome was rated as high-quality evidence according to the GRADE criteria. There were insignificant differences between the rates of recurrence after AMT and CAG (RR = 1.51; 95% CI, 0.63–3.65). However, this result was rated as low-quality evidence. Regarding adverse events, patients treated using AMT showed significantly lower rates of adverse events than those treated using CAG (RR = 0.46; 95% CI, 0.22–0.95). However, this finding was rated as low-quality evidence as well. CAG + MMC showed a safety profile comparable to that of surgical excision with CAG alone (RR = 1.81; 95% CI, 0.40–8.31). This result was also rated as low-quality evidence.ConclusionA single intraoperative topical application of 0.02% MMC during excision of pterygium followed by CAG has significantly shown to decrease the rate of pterygium recurrence to 1.4% with no severe complications.

Background Dry eye disease (DED) is a disease caused by a reduced volume or deficient quality of tears and is treated mainly with tear supplementation. There is emerging evidence that nicotinic nasal sprays are effective for DED. Our systematic review and meta-analysis assessed the efficacy and safety of varenicline nasal spray (OC-01) for DED treatment utilizing the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Methods Medline, Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases were searched. Only randomized controlled trials (RCTs) that evaluated the efficacy of OC-01 versus placebo were included. The mean change in the Schirmer test score from baseline on day 28 was the efficacy endpoint. Serious adverse events (SAEs), nonserious adverse events (NSAEs), and the rate of mortality were the safety endpoints. The standardized mean difference (SMD) was used for continuous outcomes, while the risk ratio (RR) was used to demonstrate dichotomous variables. Data pooling was performed using the inverse variance weighting technique. The certainty of evidence was rated using the GRADE approach. The risk of bias assessment was conducted using the Revised Cochrane risk of bias tool for randomized trials. Results Three RCTs (n = 1063) met the eligibility criteria. All RCTs had a low risk of bias. Meta-analysis found a statistically significant increase in the mean STS change from baseline on day 28 (SMD = 5.70, 95% CI 3.40 − 7.99 P < 0.00001, I2 = 99%). The pooled analysis found no significant difference between OC-01 and placebo in the frequency of SAEs (RR = 0.99, 95% CI 0.49–2.00, P = 0.98, I2 = 8%) or mortality (RR = 1.05, 95% CI 0.16–7.16, P = 0.96, I2 = 0%). However, OC-01 had a significant effect on developing NSAEs (RR = 1.88, 95% CI 1.51–2.34, P < 0.00001, I2 = 75%). Conclusion OC-01 had a highly significant increase in the efficacy endpoints but caused an increased frequency of NSAEs. OC-01 did not correlate with either SAEs or mortality. The RCTs included in our study had a low risk of bias assessment. Nevertheless, they were downgraded in multiple domains upon GRADE assessment.