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Topical diquafosol versus hyaluronic acid for the treatment of dry eye disease: a meta-analysis of randomized controlled trials

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Abstract

Background

Diquafosol enhances fluid transfer and mucin secretion on ocular surface, which has been suggested as an effective treatment for dry eye disease (DED). The aim of the systematic review and meta-analysis was to compare the efficacy and safety of topical diquafosol versus hyaluronic acid (HA) for DED.

Methods

Relevant randomized controlled trials were obtained via search of electronic including PubMed, Embase, Cochrane Library, and Web of Science. A random-effects model was used to pool the results after incorporating the influence of potential heterogeneity.

Results

A total of nine RCTs involving 1295 patients with DED were included in the meta-analysis. Compared to treatment with 0.1% HA, topical treatment with 3% diquafosol significantly improved the Ocular Surface Disease Index (mean difference (MD): − 3.59, 95% confidence interval (CI): − 4.68 to − 2.50, p < 0.001; I2 = 6%), results of Schirmer’s test (MD: 1.08 mm, 95% CI: 0.41 to 1.76, p = 0.002; I2 = 0%), tear breakup time (MD: 0.60 s, 95% CI: 0.20 to 0.99, p = 0.003; I2 = 63%), corneal fluorescein staining score (MD: − 0.20, 95% CI: − 0.37 to − 0.03, p = 0.02; I2 = 58%), and ocular rose bengal staining score (MD: − 0.62, 95% CI: − 0.88 to − 0.35, p < 0.001; I2 = 15%). No severe adverse events were reported. Topical use of diquafosol was associated with a higher risk of overall adverse events as compared to HA (odds ratio: 1.71, 95% CI: 1.08 to 2.71, p = 0.02; I2 = 18%).

Conclusions

Topical treatment with 3% diquafosol may be more effective than 0.1% HA for patients with DED. However, the long-term efficacy and tolerability of diquafosol still need to be determined.

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Authors and Affiliations

  1. Department of Ophthalmology, The Fourth People’s Hospital of Shenyang Affiliated to China Medical University, No. 20 Huanghe South Street, Huanggu District, Shenyang, 110031, China

    Xiaonan Sun, Lei Liu & Chi Liu

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  2. Lei Liu
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Contributions

Xiaonan Sun and Chi Liu designed the study. Xiaonan Sun and Lei Liu performed the literature search, study selection, quality evaluation, and data extraction. Xiaonan Sun and Chi Liu performed the statistical analyses and interpreted the results. Xiaonan Sun drafted the manuscript. All authors revised the manuscript and approved the submission.

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Correspondence to Chi Liu.

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Sun, X., Liu, L. & Liu, C. Topical diquafosol versus hyaluronic acid for the treatment of dry eye disease: a meta-analysis of randomized controlled trials. Graefes Arch Clin Exp Ophthalmol 261, 3355–3367 (2023). https://doi.org/10.1007/s00417-023-06083-4

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