Œil sec : évaluation de l'acupuncture

1. Revues systématiques et méta-analyses

☆☆☆ Preuves en faveur d’une efficacité et d’un effet spécifique de l’acupuncture
☆☆ Preuves en faveur d’une efficacité de l’acupuncture
Preuves limitées en faveur d’une efficacité de l’acupuncture
Ø Absence de preuve ou preuves insuffisantes

1.1. Acupuncture générique

1.1.1. Kim 2018 ☆☆

Kim BH, Kim MH, Kang SH, Nam HJ. Optimizing acupuncture treatment for dry eye syndrome: a systematic review. BMC Complement Altern Med. 2018;18(1):145. [165748].

Background In a former meta-analysis review, acupuncture was considered a potentially effective treatment for dry eye syndrome (DES), but there were heterogeneities among the outcomes. We updated the meta-analysis and conducted subgroup analysis to reduce the heterogeneity and suggest the most effective acupuncture method based on clinical trials.
MethodsWe searched for randomized controlled trials (RCTs) in 10 databases (MEDLINE, EMBASE, CENTAL, AMED, SCOPUS, CNKI, Wangfang database, Oriental Medicine Advanced Searching Integrated System (OASIS), Koreamed, J-stage) and searched by hand to compare the effects of acupuncture and artificial tears (AT). We also conducted subgroup analysis by (1) method of intervention (acupuncture only or acupuncture plus AT), (2) intervention frequency (less than 3 times a week or more than 3 times a week), (3) period of treatment (less than 4 weeks or more than 4 weeks), and (4) acupoints (BL1, BL2, ST1, ST2, TE23, Ex-HN5). The Bucher method was used for subgroup comparisons.
Results Nineteen studies with 1126 patients were included. Significant improvements on the Schirmer test (weighted mean difference[WMD], 2.14; 95% confidence interval[CI], 0.93 to 3.34; p = 0.0005) and break up time (BUT) (WMD, 0.98; 95% CI, 0.79 to 1.18; p < 0.00001) were reported. In the subgroup analysis, acupuncture plus AT treatment had a weaker effect in BUT but a stronger effect on the Schirmer test and a better overall effect than acupuncture alone. For treatment duration, treatment longer than 1 month was more effective than shorter treatment. With regard to treatment frequency, treatment less than three times a week was more effective than more frequent treatment. In the acupoint analysis, acupuncture treatment including the BL2 and ST1 acupoints was less effective than treatment that did not include them. None of those factors reduced the heterogeneity.
Conclusions Acupuncture was more effective than AT in treating DES but showed high heterogeneity. Intervention differences did not influence the heterogeneity.

1.1.2. Jiang 2017

Jiang Hui-ru, Liu Su-jun, Liu Peng, Xu Si-wei, Yang Yang, Zhang Kai-yong, Shou Yin, Zhang Bi-meng. Acupuncture for dry eye syndrome: a meta-analysis of randomized controlled trials Journal of Acupuncture and Tuina Science. 2017;15(4):263-269. [27825].

Objective To summarize and critically assess the evidence from randomized controlled trials (RCTs) of acupuncture in treating dry eye syndrome (DES) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Cochrane Collaboration recommendations.
Methods A search of PubMed, the Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and Embase was made from their inception to August 2016, as well as Chinese, Japanese, and Korean databases. Two reviewers independently selected RCTs and assessed the methodological quality. Meta-analysis and the level of evidence were processed by RevMan 5.3 and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.
ResultsAfter selection, 8 trials were subjected to our systematic review. The methodological quality was low generally. The 3-10 weeks follow-up showed that acupuncture improved the tear film break-up time (BUT) (MD=1.33, 95%CI=1.01-1.66, 619 participants). The mean difference of Schirmer's test was 1.73 mm (95%CI=1.28-2.18, 618 participants) between the acupuncture group and the control group. The subjective variables exhibited no significant differences.
ConclusionThe low methodological quality of the trials does not suggest drawing firm conclusions on the value of acupuncture therapy for DES. Acupuncture treatment may have some effects on the tear film BUT and Schirmer's test, but not on the subjective symptoms. Well-planned large-scale high-quality RCTs are needed to make it clear whether acupuncture is effective in treating DES.

1.1.3. Sheng 2015 ☆

Sheng Xueyan, Yan Xingke, Xing Jiaming. [Meta-analysis on acupuncture for dry eyes based on the clinical literatures: a randomized controlled trial]. Journal of Gansu College of Traditional Chinese Medicine. 2015;1:56-60. [186999].

Objective To assess the evidence of efficacy and safety of acupuncture for dry eyes and analyze the current situation of its clinical setting.
Methods The clinical literatures about acupuncture treatment for dry eyes in Wanfang, Chongqing Weipu Database for Chinese Technical Periodicals (VIP), China National Knowledge Infrastructure (CNKI), Pubmed and CBM clinical literature were searched systemically. Randomized controlled trials (RCT) and controlled clinical trials (CCT) that compared the effect of acupuncture for dry eyes with drug treatment were enrolled into the study. The methodological quality of included trials were assessed based on the modified Jadad scale. Valid data were facilitated by using Rev Man 5. 2.
Results 8 trials involving 553 participants satisfied the minimum criteria for meta-analysis. The evidence showed that the overall effective rate of treatment within the group receiving acupuncture was higher than that in drug group, there were statistically significant differences (P<0. 05).
Conclusion The overall effective rate of acupuncture for dry eyes is significantly superior to drug treatment, and has no obvious adverse reactions. But given the lack of high quality randomized controlled research, and the existence of literature publication bias, it needs more well-designed, randomized controlled clinical trials to confirm the effect.

1.1.4. Su 2014 ☆☆

Su Jing, Liu Xinquan, Miao Wanhong. [Acupuncture therapy in treating keratoconjunctivitis sicca: a systematic review]. China Journal of Chinese Ophthalmology. 2014;1:40-46. [186907].

Objective To evaluate the effectiveness of acupuncture treatment for keratoconjunctivitis sicca.
Methods The databases such as PubMed, CNKI, VIP and WanFang Data were searched for collecting randomized controlled clinical trials which used acupuncture therapy for treating keratoconjunctivitis sicca from the date of Jan 2004 to Dec 2012. Studies were screened, data were extracted and the methodological quality was assessed by two reviewers independently. We used RevMan 5. 1 software to complete Meta-analyses.
Results Twelve trials involving 694 patients were included. Meta-analysis showed that acupuncture therapy could increase the difference of ocular surface symptom index between pre-treatment and post-treatment (SMD=-0. 63, 95%CI [-0. 91, -0. 35], P<0. 000 01) compared with artificial tears. The meta-analysis indicated that acupuncture therapy had increased the tear output before and after treatment compared with artificial tears significantly (SMD =1. 27, 95% CI [0. 79, 1. 76], P <0. 000 01). It also indicated that acupuncture therapy could increase the difference of tear film break-up time between pre-treatment and post-treatment (SMD=0. 87, 95%CI [0. 51, 1. 23], P<0. 000 01) compared with artificial tears. The meta-analysis indicated that acupuncture therapy could not increase the range of corneal fluorescein staining scores change before and after treatment compared with artificial tears significantly (SMD=0. 01, 95%CI [-0. 24, 0. 26], P=0. 96). It also indicated that acupuncture therapy could increase the overall effect rate between pretreatment and post-treatment (SMD=0. 87, 95%CI [0. 51, 1. 23], P<0. 000 01) compared with artificial tears.
Conclusions According to evidences, acupuncture therapy could relieve Keratoconjunctivitis Sicca patients’ ocular symptom significantly compared with artificial tears. More specifically, acupuncture therapy could improve the quality of tears as well as the increase of tear output.

1.1.5. Liu 2012 ☆

Liu Min, Liu Mailan, Yu Meiling, Lan Lei, Yin Haiyan, Luo Ling, Tang Yong, Song Jiantao. [Acupuncture therapy for dry eye: a systematic review]. Chinese Journal of Chinese Ophthalmology. 2012;4:242-246. [186938].

Objective To evaluate the efficacy and safety of acupuncture therapy for dry eye.
Methods We searched the randomized controlled trials of acupuncture therapy for dry eye. Search methods included electronic search, hand search and websites complement search. Languages were limited to Chinese and English. According to the Cochrane Handbook for Systematic Reviews of Interventions (5. 1. 0), we assessed the quality of the trials. The statistical analysis was managed by RevMan 5. 1. 0 software provided by Cochrane Collaboration.
Results 1. Eight RCTs met the inclusion criteria, including 1 medium quality study, 7 low quality studies. 2. The results of meta-analysis indicated that significant difference had been found among acupuncture alone or acupuncture with artificial tears or artificial tears alone. The efficacy of the former was prior to artificial tears in increasing tear secretion and break-up time of tears of patients with dry eye. 3. Among 8 studies which was descriptively analyzed, 2 studies showed that acupuncture with artificial tears was superior to artificial tears in improving dryness and ocular fatigue; while 5 studies indicated that acupuncture with artificial tears had the same efficacy with artificial tears in improvement of symptoms, increasing tear secretion and alleviating the ocular surface damage. One study showed that artificial tears were probably more effective than acupuncture in increasing tear film stability of patients with dry eye.
Conclusions Acupuncture or acupuncture with artificial tears would be a more effective treatment to improve the symptoms, increase the tear secretion and tear film stability in patients with dry eye, compared with artificial tears. However, it still needs high-quality randomized controlled trials to verify the efficacy and safety of acupuncture therapy for dry eye.

1.1.6. Lee MS 2011 ☆

Lee Ms, Shin Bc, Choi Ty, Ernst E. Acupuncture for treating dry eye: a systematic review. Acta Ophthalmol. 2011;89(2):101-6. (eng). [156320]

Purpose The objective of this review was to assess the effectiveness of acupuncture as a treatment option for treating the condition of dry eye.
Methods We searched the literature using 14 databases from their inceptions to 3 December 2009, without language restrictions. We included randomized clinical trials (RCTs) comparing acupuncture with conventional treatment. Their risk of bias was assessed using Cochrane criteria.
Results Six RCTs met all the inclusion criteria. Three RCTs compared the effects of acupuncture with artificial tears in patients with xerophthalmia or Sjögren syndrome. A meta-analysis of these data showed that acupuncture improved tear break-up times (p < 0.0001), Schirmer test scores (p < 0.00001), response rates (p = 0.002) and the region of cornea fluorescent staining (p = 0.0001) significantly more than artificial tears did. The other three RCTs compared the effects of acupuncture plus artificial tears with artificial tears alone. Two of these studies failed to show significant effects of acupuncture, while one reported significant effects. For Schirmer test scores and frequency of artificial tear usage, two RCTs reported superior effects of acupuncture plus artificial tears, while one RCT failed to do so.
Conclusion These results provide limited evidence for the effectiveness of acupuncture for treating dry eye. However, the total number of RCTs, the total sample size and the methodological quality were too low to draw firm conclusions.

1.2. Comparaison de techniques d'acupuncture

1.2.1. Wei 2020

Wei QB, Ding N, Wang JJ, Wang W, Gao WP. Acupoint selection for the treatment of dry eye: A systematic review and meta-analysis of randomized controlled trials. Exp Ther Med. 2020;19(4):2851-2860. [207791]. doi

BackgroundThe effectiveness of acupuncture in the treatment of dry eye has been confirmed, but the association between acupoint selection and therapeutic effect has remained to be elucidated.
Obejctive In the present study, a systematic review and meta-analysis were performed to evaluate the effect of periocular acupoints and periocular acupoints plus body acupoints compared with AT for the treatment of dry eye disease (DED).
MethodsThe PubMed, Cochrane Library, Embase, Ovid, China National Knowledge Infrastructure and Chonqing VIP Information, Co., Ltd. databases were searched with entries until 10 July 2018 considered. Only randomized controlled trials (RCTs) were included. Meta-analyses were performed to compare the effects of acupuncture with those of conventional treatment (including AT or other non-acupuncture therapies). The primary outcomes, including tear break-up time (BUT), Schirmer's I test (SIT) result and Symptom scores were analyzed. Subgroup analysis was performed for periocular acupoints only and periocular acupoints plus body acupoints.
Results and conclusions A total of 12 studies comprising 900 participants were included. In the primary meta-analysis, a significant improvement in the BUT [n=1,209, weighted mean difference (WMD)=1.01, 95% CI: 0.56-1.84, P<0.00001], SIT result (n=1,107, WMD=1.98, 95% CI: 0.44-3.34, P<0.00001) and Symptom scores (n=402, WMD=-1.02, 95% CI: -1.33 to -0.72, P<0.00001) was obtained to evaluate the clinical efficacy of acupuncture and AT. Furthermore, periocular acupoints plus body acupoints were more effective in the treatment of DED. However, the total sample size of subjects with only periocular acupoints in the treatment of DED was too small to get any firm conclusions. Further large RCTs are warranted.

1.2.2. Kim 2018

Kim BH, Kim MH, Kang SH, Nam HJ. Optimizing acupuncture treatment for dry eye syndrome: a systematic review. BMC Complement Altern Med. 2018;18(1):145. [165748].

Background In a former meta-analysis review, acupuncture was considered a potentially effective treatment for dry eye syndrome (DES), but there were heterogeneities among the outcomes. We updated the meta-analysis and conducted subgroup analysis to reduce the heterogeneity and suggest the most effective acupuncture method based on clinical trials.
MethodsWe searched for randomized controlled trials (RCTs) in 10 databases (MEDLINE, EMBASE, CENTAL, AMED, SCOPUS, CNKI, Wangfang database, Oriental Medicine Advanced Searching Integrated System (OASIS), Koreamed, J-stage) and searched by hand to compare the effects of acupuncture and artificial tears (AT). We also conducted subgroup analysis by (1) method of intervention (acupuncture only or acupuncture plus AT), (2) intervention frequency (less than 3 times a week or more than 3 times a week), (3) period of treatment (less than 4 weeks or more than 4 weeks), and (4) acupoints (BL1, BL2, ST1, ST2, TE23, Ex-HN5). The Bucher method was used for subgroup comparisons.
Results Nineteen studies with 1126 patients were included. Significant improvements on the Schirmer test (weighted mean difference[WMD], 2.14; 95% confidence interval[CI], 0.93 to 3.34; p = 0.0005) and break up time (BUT) (WMD, 0.98; 95% CI, 0.79 to 1.18; p < 0.00001) were reported. In the subgroup analysis, acupuncture plus AT treatment had a weaker effect in BUT but a stronger effect on the Schirmer test and a better overall effect than acupuncture alone. For treatment duration, treatment longer than 1 month was more effective than shorter treatment. With regard to treatment frequency, treatment less than three times a week was more effective than more frequent treatment. In the acupoint analysis, acupuncture treatment including the BL2 and ST1 acupoints was less effective than treatment that did not include them. None of those factors reduced the heterogeneity.
ConclusionsAcupuncture was more effective than AT in treating DES but showed high heterogeneity. Intervention differences did not influence the heterogeneity.