A Systematic Review Of The Efficacy And Safety Of Acupuncture In The Treatment Of Ophthalmoplegia

Objective:This systematic review is to evaluate effectiveness and safety of acupuncture treating ophthalmoplegia, is to provide evidence for the clinical application of acupuncture treating ophthalmoplegia, and to point out the direction and thread for future clinical studies. Method:instituting strict inclusion criteria and exclusion criteria, searching CNKI database、 wanfang database^ VIP database、CBM database、Pubmed database、Web of Science database、 PHMC database, combining with manual searches and supplementary retrieval through baidu. Evaluating therapeutic effect of acupuncture on ophthalmoplegia is mainly made via total effective rate, improvement of main clinical symptoms and safety. Cochrane Handbook 5.0’s risk of bias tool is used to evaluate the quality of final enrolled studies. Review manager 5.3 is used for data analysis from enrolled studies. Data analysis includes qualitative analysis and quantitative analysis. Effect sizes of the data from quantitative analysis are dichotomous and continuous variables. Dichotomous variables is expressed by odds ratio and its 95% confidence interval. Quantitative analysis is expressed by mean difference and its 95% confidence interval. When the means are in large difference, quantitative analysis should be expressed by standard mean difference and its 95% confidence interval. Grade profiler 3.6 is adopted to evaluate the grades of the quality of evidence. The safety evaluation will use qualitative analysis.Result:Fourteen RCT studies were involved in this systematic reviews. Four studies were about acupuncture Vs medicine on treating ophthalmoplegia. Nine studies were about acupuncture plus medicine Vs medicine on treating ophthalmoplegia. One study was about acupuncture Vs herbs treating ophthalmoplegia. All the enrolled fourteen studies used total effective rate as the most important outcome measures. Four studies used treating time as secondary outcome measures. Three studies used the improvement of main clinical symptoms as secondary outcome measures. One study used severity of disease as secondary outcome measures. Three studies used improvement of lid opening as secondary outcome measures. Three studies used improvement of diplopia as secondary outcome measures. One study used hemorheology as secondary outcome measures. All quality evaluation of enrolled studies were B degree. Meta analysis:total effective rate:acupuncture only better than medicine (M-H OR 4.66,95%CI [2.60,8.36], P< 0.00001); acupuncture plus medicine better than medicine(M-H OR 5.50,95%CI [3.40,8.90], P< 0.00001); acupuncture only better than Chinese herbs(total effective rate observation group 96.67%, controlled group 76.67%). Changes of main clinical symptoms scores:acupuncture plus medicine might better than medicine(MD 3.29,95%CI [1.28,5.30], P=0.001< 0.05); acupuncture only better than medicine. Safety evaluation:two studies reported adverse events including fainting during acupuncture and periorbital bleeding.Conclusion:this systematic review affirmed the efficacy of acupuncture treating ophthalmoplegia. Acupuncture plus medicine might better than meidicine on the improvement of the main clinical symptoms. Although there were adverse events reported, but unsafety was not proved to be existed. Due to the common quality enrolled studies and low degree evidence, reliability of the systematic review might be affected in future studies. More high quality RCT clinical studies are expected to appear and afford high degree evidence for evidence-based medicine which can further demonstrate the effectiveness of acupuncture treating ophthalmoplegia.