Background
Methods
Search strategy
Study selection
Data extraction and assessment of risk of bias
Data analysis
Results
Literary search
Study description
First author | Year | Site | Sample sizea | Age | Gender (M/F) | Regime (acupoints) | Duration (min) | Frequency (per week) | Total sessions | Outcomes |
---|---|---|---|---|---|---|---|---|---|---|
Nepp [12] | 1998 | Austria | 52 (30/22) | N/A | N/A | GB1, BL2, ST5, EX-HN2, LI4, SI3, LI3, KI6, TE5 | 30 | 1 | 10 | ST, BUT, drop frequency |
He [13] | 2004 | China | 32 (16/16) | 52 | 12/20 | Pattern identification was done by practitioner (ST2, LI20, LI11, LI4, SP6 OR ST2, SP10, SP9, SP6, ST36, KI6) | 20–25 | 3–4 (every other day) | 30 | ST, BUT, CFS |
Wang [14] | 2005 | China | 45((A)15, (B)15/15) | 51.7 | 17/28 | (A) Pattern identification was done by practitioner (LI11, LI4 SP6, KI3, ST2, LI20 or ST2, SP10, SP9, ST36, SP6, ST40) (B) BL2, TE23, GB14, ST1 | 20–25 | 3–4 (every other day) | 20 | ST, BUT, CFS, RR |
Tseng [15] | 2006 | Taiwan | 26 (17/9) | 48.9 | 12/14 | Ex-HN5, TE23, GB14, ST2, SP6 | 20 | 2 | 16 | ST, BUT, Number of application of artificial tears |
Zhang [16] | 2009 | China | 60 (30/30) | 44 | 23/37 | ST1, LR3, KI3 | 20 | N/A | N/A | ST, BUT, total symptoms |
Gong [17] | 2010 | China | 42 (20/22) | 44.8 | 11/33 | BL1, BL2, GB14, SJ23, Ex-HN5, ST2, LI4, LR3, GB37, SP6, GB20 | 20 | 3 (every other day) | 10 | ST, BUT, RBS recording, total score |
Gao [18] | 2010 | China | 56 (28/28) | 48.9 | 3/53 | BL1, BL2, TE23, GB1,Ex-HN5 | 30 | 6 | 24 | ST, BUT, total score |
Shi [19] | 2012 | China | 68 (33/35) | 49.5 | 30/38 | Ex-HN1, BL1, ST1, Ex-HN5, TE23, LI4, ST36 | 25 | 3 | 9 | ST, BUT, tear lactoferrin concentration |
Kim [20] | 2012 | Korea | 150 (75/75) | 42 | 41/109 | BL2, GB14, TE23, Ex-HN5, ST1, GB20, LI4 LI11, GV23 | 20 | 3 | 12 | OSDI, VAS, BUT, ST, MYMOP-2 |
Nan [21] | 2014 | China | 60 (30/30) | 48.1 | 25/35 | Eye acupuncture (liver/gallbladder area, kidney area, spleen stomach area, upper jiao area) | 15–20 | 7 | 20 | ST, BUT, total score |
Zhang [22] | 2015 | China | 80 (40/40) | 53 | 28/52 | Hair needle therapy (superior and inferior lacrimal puncta) | 10 | 3–4 (every other day) | 7 | ST, BUT, CFS, total score |
NI [23] | 2016 | China | 93((A)30, (B)32/31) | 33.3 | 36/57 | (A) BL1, Ex-HN7, SP6, KI3, GV26 (B) BL1, Ex-HN7, SP6, KI3 | 20 | 3 | 9 | ST BUT, subjective symptom score |
Chao [24] | 2016 | China | 53((A)18, (B)19/16) | 48.9 | 15/38 | (A), (B) GB20, Ex-HN5, BL2, ST2, LR3, KI3, SP6, SP6, ST36, ST37 (A) applied a qi-absorption needling technique to the GB20 | 30 | 7 | 28 | ST, BUT, VAS, CFS total score |
Liu [25] | 2017 | China | 28 (14/14) | 60.7 | 0/28 | BL2, BL3, TE23, Ex-HN5, ST2, LI4, GB20, GV20, ST1 | 30 | 3 | 24 | ST, BUT, OSDI, questionnaire, protein analysis |
First author | Year | Site | Sample sizea | Age | Gender (M/F) | Regime (intervention/control group) | Regime (frequency & duration) | Outcomes |
---|---|---|---|---|---|---|---|---|
Shin [26] | 2010 | Korea | 42 (21/21) | 41.6 | 11/31 | Intervention: manual acupuncture GV23, BL2, BL14, TE23, Ex-HN5, ST-1, GB20, SP3, LU9, LU10, HT8 Control: non-acupoints around same site | Needles were retained for 20 min, 3 times a week for a total of 9 times. It takes 3 weeks to complete the treatment. | BUT, SIT, VAS, OSDI |
Liu [27] | 2012 | China | 39 (20/19) | 32 | 21/19 | Intervention: electro-acupuncture with BL1, Ex-HN5, BL2, TE23, GB1, GB20, KI3, SP6, LR3 Control: Artificial tears | Everyday treatment group undergoes electroacupuncture for 30 min. For a total of 20 sessions. | SIT, BUT |
Guo [28] | 2013 | China | 47 (23/24) | 52 | 7/40 | Intervention: electro-acupuncture with shang-jingming (Ex), xia-jingming (Ex), GB1, BL2, GB20, LI4, SP6, KI3, LR3 Control: manual acupuncture with the same acupoints | Needles were retained for 20 min, 3 times a week for a total of 12 times. It takes 4 weeks to complete the treatment. | BUT, SIT, VAS |
Gao [29] | 2016 | China | 88 (44/44) | 41.8 | 33/55 | A: pyonex combined with acupuncture, SP6, ST36, PC6, LR3 are the main points, and pattern identification was done (BL13, LI4 OR BL20, ST40 OR BL18, BL23) B: manual acupuncture with GV20, ST1, BL2, GB20, Ex-HN5, TE23 | A: pyonex was embedded for 3 days. The follwing day, it was embedded again. This process was repeated four times and followed by two days free from embedment. After that, another four courses of embedment were conducted. B: needles were retained for 30 min every day for 12 days. Two days rest were followed by another 12 days of treatment. | SIT BUT, total score |
Wu [30] | 2016 | China | 40 (20/20) | 44.2 | 10/30 | Intervention: BL2, ST2, Ex-HN5 Control: artificial tears | Treatment group undergoes embedding therapy (retained for 24 h) on alternate days for 7 sessions. | BUT, SIT, OSDI |
Risk of bias assessment
Meta-analysis between manual acupuncture and artificial tears
Subgroup analysis
Variables | Number of studies | Number of eyes | SMD | 95%CI | Heterogeneity (I2) | MD (95% CI) | ||
---|---|---|---|---|---|---|---|---|
Acupuncture | AT | |||||||
Duration | Short term | 7 | 586 | 488 | 0.54 | 0.30–0.78 | 86% | −0.41 (−1.10, 0.28) |
Long term | 4 | 148 | 106 | 0.95 | 0.30–1.59 | 87% | ||
Frequency | Less frequent | 4 | 250 | 208 | 0.49 | 0.19–0.79 | 79% | −0.22 (−0.67, 0.22) |
Intensive | 7 | 484 | 386 | 0.71 | 0.37–1.05 | 90% | ||
BL1 | Included | 4 | 270 | 214 | 0.60 | 0.29–0.91 | 81% | −0.04 (−0.49, 0.41) |
Not included | 7 | 464 | 380 | 0.64 | 0.32–.0.96 | 89% | ||
BL2a | Included | 4 | 264 | 264 | 0.35 | 0.11–0.60 | 71% | −0.46 (− 0.86, − 0.06) |
Not included | 8 | 470 | 360 | 0.81 | 0.49–1.12 | 89% | ||
ST1a | Included | 5 | 330 | 336 | 0.28 | 0.01–0.52 | 77% | −0.63 (−1.02, − 0.24) |
Not included | 7 | 404 | 288 | 0.91 | 0.60–1.22 | 85% | ||
ST2 | Included | 4 | 148 | 106 | 0.95 | 0.30–1.59 | 91% | 0.41 (−0.28, 1.10) |
Not included | 7 | 586 | 488 | 0.54 | 0.30–0.78 | 86% | ||
TE23a | Included | 6 | 354 | 348 | 0.59 | 0.25–0.96 | 88% | −0.10 (− 0.55, 0.35) |
Not included | 6 | 380 | 276 | 0.69 | 0.40–0.99 | 87% | ||
Ex-HN5 | Included | 6 | 398 | 350 | 0.60 | 0.27–0.93 | 88% | −0.03 (−0.56, 0.50) |
Not included | 5 | 336 | 244 | 0.63 | 0.30–0.96 | 86% |