Efficacy Of Sex Hormone Therapy For Treating Dry Eye Syndrome In Peri- And Post-menopausal Women: A Meta-analysis

Background:Menopause is a very complicated physiological process in a woman’s life. A series of menopausal symptoms occurs with the gradual decline of ovarian function which affect the women’s physical and mental health seriously. Hormone replacement therapy is applied for menopausal symptom management in women in clinical use for recent years, and it brings great benefits for perimenopausal and postmenopausal women. Despite hormone replacement therapy has achieved remarkable achievements in treating menopausal related diseases, some controversial issues still exist. As we all known, dry eye syndrome is a menopausal related chronic disease. According to the existing evidence, the treatment efficacy of sex hormone on perimenopausal and postmenopausal women presenting with dry eye still remains debatable.Objective:To evaluate the efficacy of sex hormone therapy in peri-menopausal and post-menopausal women with dry eye syndrome by the method of Meta-analysis, in order to provide reliable theoretical basis for clinical work. Methods:A number of online database include Pubmed, Embase, Cochrane, Medline, Web of science, CNKI, Wanfang database, Weipu database were comprehensively retrieved. Meanwhile manual searching was involved in journals of Jilin University Medical Library which were related with sex hormone therapy in peri-menopausal and post-menopausal women. After all these procedures, two reviewers collect all the literatures which were searched for relevant in English and Chinese from January 1990 to January 2016. Then both of them screen documents independent, bring into studies met criteria, evaluate the included studies, data extraction and data conversion dependently. Finally, use Rev Man 5.3 software offered by the Cochrane collaboration to complete the Meta-analysis. Results:This Meta-analysis has collected 10 randomized-controlled groups which were published in English and Chinese after careful screening. Among total 825 cases, there were 413(50%) women treated by sex hormone therapy. The Meta-analysis showed:(1)among the included three groups, the total efficiency(OR=3.15, 95%CI(2.11,4.49), P<0.00001) and significant efficiency(OR=2.11, 95%CI(1.45,3.07), P=0.0001) of sex hormone combination conventional treatment groups were higher than conventional treatment groups.(2)among the included three groups, no significant difference was noted in efficiency between sex hormone combination conventional treatment groups and conventional treatment groups(OR=1.06, 95%CI(0.76,1.49), P=0.73).(3) among the included four groups, the significant efficiency of BUT(OR=2.05, 95%CI(0.29,14.66), P=0.69) and SIT(OR=1.77, 95%CI(0.32,9.89), P=0.51) in sex hormone combination conventional treatment groups are higher than conventional treatment groups, however the difference was not statistically significant. Conclusion:As expected, the total efficiency and significant efficiency of dry eye in perimenopausal and postmenopausal women has been significantly improved with sex hormone therapy, while the efficiency of dry eye hasn`t been markedly improved. The results increased our confidence to apply sex hormone therapy for treating dry eye syndrome in perimenopausal and postmenopausal women. However, on one hand the number of included groups was small, on the other hand this Meta-analysis lacks studies about dry eye in early menopause, diminished ovarian reserve and premature ovarian failure. Therefore, it remains to be further validated with large randomized-controlled trials to determine the efficacy of sex hormone therapy for treating menopause related dry eye syndrome.