The effectiveness and safety of moxibustion for dry eye : Protocol for a systematic review

Abstract

Background: Dry eye (DE) is a common type of ocular surface disease that affects many people. Moxibustion has been widely used in China to treat ocular surface diseases, especially DE. Many clinical trials have demonstrated that moxibustion can increase the tear secretion quantity and improve tear film stability. The purpose of this review is to provide an objective and normative systematic review to evaluate the effectiveness and safety of moxibustion treatment in patients with DE. Methods:The systematic review will include all of the randomized controlled trials on the effectiveness and safety of moxibustion for DE. Nine medical databases, namely PubMed, EMBASE, the Cochrane Library, Google Scholar, Web of Science, China National Knowledge Infrastructure (CNKI), China Science and Technology Journal database (VIP), Wanfang Database, and CBM, will be searched from the date of the database inception to February 28, 2019. We will also search registers of clinical trials, potential gray literature, and conference abstracts. There are no restrictions on language and publication status. Two reviewers will independently select studies, and extract and manage data. The reporting quality and risk of bias will be assessed by other 2 review authors. The primary outcomes will include ocular surface disease index (OSDI) scores, Schirmer test (SIT) results, tear meniscus height (TMH), and tear break-up time (TBUT) values. Quality of life, the main symptom scores before and after treatment, meibomian gland (MG) morphology, total treatment efficacy, and safety will be evaluated as the secondary outcomes. We will use RevMan V.5.3 software to synthesize and analyze data. Results: This systematic review will provide a comprehensive review of current evidence of moxibustion for DE from the following aspects: The OSDI, SIT, TMH, BUT, quality of life, the main symptom scores, MG morphology, total treatment efficacy, and safety. Conclusion: The conclusion of our systematic review will provide evidence to determine whether moxibustion is an effective and safe intervention for patients with DE. Ethics and dissemination: Since patients will not be involved in this study, it is not necessary to obtain ethical approval. The protocol and results will be published in a peer-reviewed journal. PROSPERO registration number: PROSPERO CRD42018097399. Abbreviations: ATs = artificial tears, CI = confidence interval, CNKI = China National Knowledge Infrastructure, DE = dry eye, DES = dry eye syndrome, GRADE = Grades of Recommendation, Assessment, Development, and Evaluation, ICTRP = International Clinical Trials Registry Platform, IOP = intraocular pressure, MCs = mast cells, MG = meibomian gland, OSDI = ocular surface disease index, PRISMA-P = Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocols, RCTs = randomized controlled trials, ROB = risk of bias, RR = relative risk, SIT = Schirmer test, SMD = standardized mean difference, SPK = superficial punctate keratitis, TBUT = tear break-up time, TCM = Traditional Chinese Medicine, TMH = tear meniscus height, TRPV = transient receptor potential vanilloid, VIP = China Science and Technology Journal database, WMD = weighted mean difference.