O uso de colírios lubrificantes sem preservativos comparado aos lubrificantes com preservativos no tratamento do olho seco: revisão sistemática com metanálise

Abstract

Ocular lubricants or artificial tears are the conventional dry eye treatment. Most of these eye drops need to receive preservatives in their composition to prevent microbial contamination. In vitro studies, preservatives may cause eye surface irritation and cytotoxicity but the drops without preservatives are expensive and difficult to handle. There is a lack of clinical trials comparing effectiveness and safety between the use of artificial tears with and without preservatives on dry eye in the literature. Therefore, the objective of this systematic review of randomized clinical trials, was to evaluate the effectiveness and security of the use of artificial tears without preservatives compared to lubricants preserved in dry eye treatment at the Federal University of Alagoas. We searched databases online (LILACS, EMBASE, MEDLINE and CENTRAL) from the inception of the database until April 2018; references of the included articles were also searched. The search strategy used the terms: lubricants OR artificial tears OR artificial tears, lubricants AND dry eye OR dry eye syndrome OR syndromes, dry eye. From the 2040 electronic search results, 29 complete articles were retrieved, of which 4 were relevant, and evaluated evaluated in terms of methodological quality. Of these, the number of participants ranged from 15 to 76. Only one study had more items with low risk of bias, the others presented undetermined or high risk of bias. Meta-analysis was possible for the following variables: outcome score for OSDI (Ocular Surface Disease Index) (mean difference = 0,37; CI 95%: -2,35 a 1,61; P = 0,72; I2 = 0 %), tear secretion rate by Schirmer's test (mean difference= 0,12 CI 95%: -1,24 a 1,49; P = 0,86; I2 = 0%), tear evaporation rate by TBUT test (Tear Break Up time) (mean difference=0,20, CI 95%: -0,85 a 0,44; P = 0,54; I2 = 0%), burning, foreign body sensation and photophobia (mean difference= 0,07, IC 95 %: -0,17 a 0,30; P = 0,59; I2 = 89%), (mean difference= 0,00, IC 95%: -0,06 a 0,07; P = 0,59; I2 = 0%) and mean difference=0,01, IC 95%: -0,06 a 0,07; P = 0,62; I2 = 0%) respectively; and there was no statistical significance between the two groups in outcomes and without reporting adverse effects attributed to the intervention or the control group. We concluded that there was insufficient evidence that preservative-free eye drops were more effective than preservatives because of poor methodological quality of selected papers.