Meta analysis of the topical administration of cyclosporine A in the prevention of pterygium recurrence / 中华实验眼科杂志

ABSTRACT

Background Pterygium is a common ocular surface disease and its treatment is surgical excision.But recurrence rate of pterygium is high after operation.Recently,some studies showed that the postoperatively topical administration of cyclosporine A (CsA) reduce the recurrence of pterygium,but this conclusion needs basis of evidence-based medicine.Objective This systematic review was to investigate the efficacy and safety of postoperatively topical usage of CsA in preventing the recurrence of primary pterygium.Methods A systematic literature retrieval was conducted and the relative articals were searched from MEDLINE,EMBASE,Cochrane Library,CNKI,Wanfang and VIP databases up to October 2012 according to searching strategy and correlated words.Randomized controlled trial (RCT) and prospective Cohort studies data were extracted by two researchers separately.The outcome parameters,such as the rate of recurrence,Schirmer Ⅰ test (S Ⅰ t) and complications were analyzed.The statistical analysis of the relative risk (RR) or weighted mean difference (WMD) was performed using a RevMan 5.0 software.Fixed-effect model was used for the inhomogeneity multiple studies (P≥0.1,homogeneity test I2 ＜ 50％),and random-effect model was used for the homogeneity study.Results Six prospective studies involving 366 eyes of 309 participants were identified,including 4 RCT and 2 non-RCT.The literature was published in 2008-2012 with the Jadad 5 scores in 1 paper and 2 scores in 3 papers for RCT and 6-7NOS (The Newcastle-Ottawa Scale) scores in 2 papers for Cohort studies.Meta-analysis showed that the recurrence and complication rates were significantly lower in the CsA group than those of the control group (RR =0.39,95 ％ CI0.24-0.64,P =0.0002 and RR =0.24,95％ CI0.13-0.44,P ＜ 0.00001) respectively.The postoperatively increased value of S Ⅰ t in the CsA group was significantly higher than that of the control group (WMD =2.47,95％CI1.59-3.35,P ＜ 0.00001).Subgroups analyses suggested that the results were comparatively reliable.Conclusions Postoperative application of CsA can be effective for preventing recurrences and reducing complications after primary pterygium surgery.