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TFOS DEWS二期管理和治疗报告 TFOS DEWS II Management and Therapy Report

Jones L, Downie LE, Korb D, Benitez-Del-Castillo JM, Dana R, Deng SX, Dong PN, Geerling G, Hida RY, Liu Y, Seo KY, Tauber J, Wakamatsu TH, Xu J, Wolffsohn JS, Craig JP

期刊名称:The Ocular Surface

卷期:2017年第15卷第3期

关键词:
报告

摘要

摘要:管理和治疗委员会小组成员对目前干眼症治疗和管理方案进行了循证审查。管理选项的审查具体包括对泪液缺乏、眼睑异常的治疗,以及抗炎药物、手术方法、饮食习惯的改变、环境因素以及补充疗法。经过这次广泛审查,很明显,现存的很多用于治疗干眼症的治疗方法缺乏必要的一级证据来支持它们的推荐。通常是由于缺少适当的遮蔽,随机化或控制,在某些情况下是由于选择偏差或是样本量不足导致的。回顾所有现存的证据,一种进阶管理算法被提出来,它提供了一种可以根据病情严重程度实施不同管理和治疗选择的步进式方法。然而测试表明,在选择最适合管理策略时,区分泪液缺乏型和蒸发型干眼症至关重要。报告同时强调了在管理这两种干眼症亚型时,根据目前可用的有限证据来预测具体管理方式的相对收益时所面临的挑战。目前还需要进一步证据来支持现有的很多关于管理干眼病治疗方案的介绍以及沿用,并告知适当的治疗起点以及了解关于干眼症不同亚型的特异性。

 

The members of the Management and Therapy Subcommittee undertook an evidence-based review of current dry eye therapies and management options. Management options reviewed in detail included treatments for tear insufficiency and lid abnormalities, as well as anti-inflammatory medications, surgical approaches, dietary modifications, environmental considerations and complementary therapies. Following this extensive review it became clear that many of the treatments available for the management of dry eye disease lack the necessary Level 1 evidence to support their recommendation, often due to a lack of appropriate masking, randomization or controls and in some cases due to issues with selection bias or inadequate sample size. Reflecting on all available evidence, a staged management algorithm was derived that presents a step-wise approach to implementing the various management and therapeutic options according to disease severity. While this exercise indicated that differentiating between aqueous-deficient and evaporative dry eye disease was critical in selecting the most appropriate management strategy, it also highlighted challenges, based on the limited evidence currently available, in predicting relative benefits of specific management options, in managing the two dry eye disease subtypes. Further evidence is required to support the introduction, and continued use, of many of the treatment options currently available to manage dry eye disease, as well as to inform appropriate treatment starting points and understand treatment specificity in relation to dry eye disease subtype.


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