Polycystic Ovary Syndrome and Dry Eye Disease: A Systematic Review and Meta-Analysis

The current meta-analysis reviewed the dry eye symptomatology and tear film differences between PCOS and healthy women. PubMed, Cochrane Library, and Scopus were searched for prospective/cross-sectional studies on patients with PCOS where at least one tear film parameter or dry eye symptomatology had been tested and compared with healthy controls. The analyzed data were changes in ocular surface disease index scores (OSDI), tear film break-up time (TBUT), Schirmer values, and Meibography. RevMan software was used for meta-analysis, and weighted mean differences (MD) were computed along with GRADE evidence level determination. Thirteen articles were included, and PCOS (n = 639) was diagnosed using the Amsterdam (n = 2) or Rotterdam (n = 11) criteria. Studies were heterogeneous (I2 > 75%) for all analyzed parameters. OSDI (MD 7.5, 95% CI 1.4 to 13.6, p = 0.02) and invasive TBUT (MD −3.1s, 95% CI −4.7 to −1.6, p p = 0.12) and noninvasive TBUT (MD −2.1, 95% CI −4.2 to −0.03, p = 0.05) were similar between PCOS and healthy controls. Forest plots revealed an overall MD estimate of all parameters to lie close to the null effect line. All studies had a low level of certainty regarding evidence. Women with PCOS can experience mild dry eye symptoms; however, tear volume and tear film stability are similar in women with PCOS and those without the condition. In most studies, tear film parameters of PCOS women do not meet DEWS II criteria for DED diagnosis, though they are heterogeneous and have low levels of certainty.本项元分析（meta-analysis）旨在探讨多囊卵巢综合征（Polycystic Ovary Syndrome, PCOS）女性与健康女性的干眼症状学特征及泪膜差异。本研究检索了PubMed数据库、考克兰图书馆（Cochrane Library）及Scopus数据库中，针对多囊卵巢综合征患者开展的、至少纳入一项泪膜参数或干眼症状学检测并与健康对照人群进行比较的前瞻性/横断面研究。本次分析纳入的指标包括眼表疾病指数（ocular surface disease index, OSDI）评分、泪膜破裂时间（tear film break-up time, TBUT）、施墨试验值及睑板腺照相术（meibography）结果。本研究采用RevMan软件进行元分析，计算加权均数差（weighted mean difference, MD）并确定GRADE（Grading of Recommendations Assessment, Development and Evaluation）证据等级。最终纳入13项研究，共纳入多囊卵巢综合征患者639例（n=639），其诊断标准采用阿姆斯特丹标准（Amsterdam criteria, n=2）或鹿特丹标准（Rotterdam criteria, n=11）。所有纳入分析的参数均存在显著异质性（I²>75%）。眼表疾病指数评分的加权均数差为7.5（95%置信区间[CI] 1.4~13.6，p=0.02）；有创泪膜破裂时间的加权均数差为-3.1s（95%CI -4.7~-1.6，p=0.12），无创泪膜破裂时间的加权均数差为-2.1（95%CI -4.2~-0.03，p=0.05），多囊卵巢综合征患者与健康女性的上述指标无显著差异。森林图结果显示，所有参数的总体加权均数差估计值均接近无效线。所有研究的证据确定性等级均较低。多囊卵巢综合征女性可出现轻度干眼症状，但二者的泪液分泌量与泪膜稳定性与健康女性无显著差异。多数研究中，多囊卵巢综合征女性的泪膜参数未达到干眼研讨会Ⅱ（Dry Eye Workshop Ⅱ, DEWS Ⅱ）制定的干眼症（Dry Eye Disease, DED）诊断标准，但相关研究存在异质性且证据确定性等级较低。