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Effectiveness of topical cycloplegics as anterior segment analgesics: systematic review and meta-analysis

Published:February 03, 2021DOI:https://doi.org/10.1016/j.jcjo.2020.12.004

      Abstract

      Objective

      Topical cycloplegic agents often are used in ophthalmology in the context of management of ocular inflammation. Preliminary searches of the literature provided little evidence to support their use in relieving pain or reducing inflammation. The goal of this study was to evaluate the current literature for any evidence regarding the effectiveness of cycloplegics for treatment of pain or inflammation in patients with anterior segment injury or inflammation through a systematic review and meta-analysis.

      Methods

      Using multiple keywords relating to cycloplegics and inflammatory and infectious eye conditions, a search was conducted on multiple scientific databases for relevant articles. A 2-level screening approach was used and articles that were relevant to the topic were included in the systematic review. Data from these articles, if applicable, were extracted for meta-analyses. Statistical assessments involved computation of I2statistics, Z-value, and χ2 statistics.

      Results

      We screened 5753 articles for relevance. Seven were included in the systematic review and 5 were included in the meta-analysis. There was considerable heterogeneity between the included studies. Statistical analysis revealed significant reductions in pain using homatropine and cyclopentolate after 2 days. Nonsignificant changes in the anterior chamber cells and flare were seen using cyclopentolate and atropine at different follow-up times.

      Conclusions

      Little published evidence exists in the literature to guide the use of cycloplegics on relieving pain and treating inflammation. Therefore, higher-quality randomized controlled trials with longer follow-up times are needed to fully understand the role that cycloplegics play in reducing pain in inflammatory conditions.

      Objectif

      Les cycloplégiques topiques sont souvent prescrits pour traiter l'inflammation oculaire. Or, des recherches préliminaires dans la littérature médicale n'ont pas fait ressortir beaucoup de données étayant leur utilité à titre d'analgésiques ou d'anti-inflammatoires oculaires. La présente étude avait donc pour objectif de trouver, dans la littérature médicale, des études sur l'efficacité des cycloplégiques dans le traitement de la douleur ou de l'inflammation secondaires à une lésion ou à une inflammation du segment antérieur et de réaliser une revue de synthèse systématique suivie d'une méta-analyse.

      Méthodes

      On a eu recours à divers mots-clés en lien avec les cycloplégiques et les atteintes oculaires inflammatoires et infectieuses pour lancer la rechercher dans plusieurs bases de données scientifiques afin d'en extraire des articles pertinents. Après avoir réalisé une démarche de sélection en 2 étapes, les articles jugés pertinents ont été inclus dans la revue de synthèse systématique. Les données de ces articles, le cas échéant, ont été extraites en vue de la méta-analyse. Les évaluations statistiques étaient les suivantes : statistique i2, valeur de Z et χ2.

      Résultats

      Nous avons évalué la pertinence de 5753 articles, dont 7 ont été inclus dans la revue de synthèse systématique et 5, dans la méta-analyse. On a noté une importante hétérogénéité entre les études. L'analyse statistique a mis au jour des réductions significatives de la douleur sous l'effet de l'homatropine et du cyclopentolate après 2 jours. Des modifications non significatives des cellules de la chambre antérieure et de la transparence du vide optique en chambre antérieure (flare) ont été observées sous l'effet du cyclopentolate et de l'atropine à différents moments du suivi.

      Conclusions

      Il existe peu de données dans la littérature médicale qui étayent le recours aux cycloplégiques pour le soulagement de la douleur et le traitement de l'inflammation. Il serait donc nécessaire de réaliser des études cliniques comparatives randomisées de meilleure qualité et comportant des suivis de plus longue durée pour bien comprendre le rôle des cycloplégiques dans le traitement de la douleur secondaire à l'inflammation oculaire.
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