SUMMARY OF FINDINGS FOR THE MAIN COMPARISON [Explanation]
| Topical antibiotics compared with placebo for anterior/mixed blepharitis (7 studies) | ||||
|---|---|---|---|---|
| Population: participants with anterior/mixed blepharitis Intervention: topical antibiotics Comparison: placebo | ||||
| Outcomes | Studies and outcomes* | Comments | ||
| Definition of outcome | Mean difference, IV, Fixed (95% CI) | No of participants (studies) | ||
| Mean scores based on 5-point rating scale (Hyndiuk 1990) | −0.90 (−1.47 to −0.33) | 39 (1 study) | 1 additional study reported no significant difference between groups in mean change from baseline of total scores based on 4-point rating scale (Shulman 1982) | |
| Proportion cured or improved (Hyndiuk 1990) | 1.53 (0.98 to 2.38) | 39 (1 study) | ||
| Proportion cured (Hyndiuk 1990) | 15.75 (0.96 to 258.08) | 39 (1 study) | ||
| Day 7 (4 studies) | ||||
| Mean change from baseline in clinical scores based on 5-point rating scale for signs and VAS for symptoms (Behrens-Baumann 2006); mean scores based on 5-point rating scale (Hyndiuk 1990); and mean scores based on 4-point rating scale of signs and symptoms, and presence or absence of additional problems (Jackson 1982) | −0.76 (−1.30 to −0.23) | 264 (3 studies) | 1 additional study reported no significant difference between groups in mean change from baseline of total scores based on 4-point rating scale (Shulman 1982) | |
| Proportion cured or improved (Hyndiuk 1990) | 1.35 (1.00 to 1.84) | 39 (1 study) | ||
| Proportion cured (Hyndiuk 1990) | 2.46 (1.19 to 5.05) | 39 (1 study) | ||
| Day 14 (4 studies) | ||||
| Mean change from baseline in clinical scores based on 5-point rating scale for signs and VAS for symptoms (Behrens-Baumann 2006); and mean scores based on 4-point rating scale of signs and symptoms, and presence or absence of additional problems (Jackson 1982) | −1.37 (−2.43 to −0.30) | 225 (2 studies) | 1 additional study reported no significant difference between groups in per cent of participants with improvement based on 4-point rating scale (Donshik 1983); 1 additional study reported no significant difference between groups in mean change from baseline of total scores based on 4-point rating scale (Shulman 1982) | |
| Other follow-up times (1 study) | ||||
| Clinical evaluation and participant questionnaires (no time point or further details provided) (Laibovitz 1991) | Not estimable | Not reported (1 study) | Study reported that participants receiving topical antibiotics were more likely to describe themselves as cured (P = 0.024); clinical improvement detected in participants with moderate disease (P = 0.034) | |
| Clinical outcomes: improvement in signs Follow-up: 3 days to 8 weeks | Day 3 (2 studies) | |||
| Mean change in scores based on 4-point rating scale for lid discharge (Donshik 1983) | Not estimable | Not reported (1 study) | Study reported no significant difference between groups | |
| Mean change from baseline based on 4-point rating scale for individual signs: lid edema, lid hyperemia (Shulman 1982) | Not estimable | 35 (1 study) | Study reported no significant difference between groups | |
| Day 7 (2 studies) | ||||
| Mean scores based on 4-point rating scale of signs, and presence or absence of additional problems (Jackson 1982) | −0.06 (−1.36 to 1.24) | 30 (1 study) | ||
| Mean change in scores based on 4-point rating scale for lid discharge (Donshik 1983) | Not estimable | Not reported (1 study) | Study reported no significant difference between groups | |
| Day 14 (3 studies) | ||||
| Mean scores based on 4-point rating scale of signs, and presence or absence of additional problems (Jackson 1982) | −0.29 (−1.60 to 1.02) | 28 (1 study) | ||
| Mean change in scores for based on 4-point rating scale for lid discharge (Donshik 1983) | Not estimable | Not reported (1 study) | Study reported no significant difference between groups | |
| Proportion with severe or very severe grading: lid edema (Behrens-Baumann 2006) | 0.35 (0.14 to 0.87) | 75 (1 study) | ||
| Proportion with severe or very severe grading: lid erythema (Behrens-Baumann 2006) | 0.46 (0.27 to 0.80) | 108(1 study) | ||
| Proportion with severe or very severe grading: lid debris (Behrens-Baumann 2006) | 0.40 (0.15 to 1.08) | 104(1 study) | ||
| Proportion with severe or very severe grading: meibomitis (Behrens-Baumann 2006) | 0.42 (0.24 to 0.74) | 109(1 study) | ||
| Other follow-up times (1 study) | ||||
| Proportion with improvement based on 5-point rating scale of signs during first 4 weeks of crossover trial (More 1968) | 1.14 (0.77 to 1.69) | 13(1 study) | ||
| Proportion with improvement based on 5-point rating scale of signs during second 4 weeks of cross-over trial (More 1968) | 0.21 (0.03 to 1.43) | 13(1 study) | ||
| Clinical outcomes: improvement in symptoms Follow-up: 7 days to 8 weeks | Day 7(1 study) | |||
| Mean scores based on 4-point rating scale of symptoms (Jackson 1982) | 0.19 (−0.65 to 1.03) | 30 (1 study) | ||
| Day 14 (2 studies) | ||||
| Mean scores based on 4-point rating scale of symptoms (Jackson 1982) | 0.04 (−0.75 to 0.83) | 28 (1 study) | ||
| Mean change in VAS rating from baseline for ocular discomfort (Behrens-Baumann 2006) | Not estimable | 197(1 study) | Study reported significant difference between groups (P = 0.011) | |
| Other follow-up times (1 study) | ||||
| Proportion with improvement based on 5-point rating scale of symptoms during first 4 weeks of cross-over trial (More 1968) | 1.14 (0.77 to 1.69) | 13(1 study) | ||
| Proportion with improvement based on 5-point rating scale of symptoms during second 4 weeks of cross-over trial (More 1968) | 1.29(0.31 to 5.31) | 13(1 study) | ||
| Bacteriologic outcomes Follow-up: 3 to 28 days | Day 3 (2 studies) | |||
| Mean bacterial colony counts (Hyndiuk 1990) | −426.00 (−539.94 to −312.06) | 39 (1 study) | 1 additional study reported that topical antibiotics were significantly more effective than placebo in rendering lid cultures negative (Shulman 1982) | |
| Day 7(1 study) | ||||
| Mean bacterial colony counts (Hyndiuk 1990) | −454.00 (−659.68 to −248.32) | 39 (1 study) | ||
| Day 14 (2 studies) | ||||
| Lid cultures (Donshik 1983; Jackson 1982) | 4.21 (2.10 to 8.44) | 70 (2 studies) | ||
| Other follow-up times (2 studies) | ||||
| Quantitative cultures (time not reported) (Laibovitz 1991) | Not estimable | Not reported (1 study) | Study reported a reduction in the incidence of positive cultures (P = 0.00000035) relative to placebo | |
| Conjunctival cultures at week 4; end of first crossover phase (More 1968) | 0.50 (0.06 to 3.91) | 10(1 study) | ||
| Adverse outcomes Follow-up: up to 8 weeks | Proportion of total adverse events: bibrocathol (Behrens-Baumann 2006), mercuric oxide (Hyndiuk 1990), and penotrane (More 1968) | 0.91 (0.60 to 1.38) | 268 (3 studies) | Individual analyses for each type of antibiotic were not significant 1 additional study reported that 3 participants receiving gentam-icin had increased ocular hyperemia and itching; no increases in IOP were detected in any group (Donshik 1983); and another reported that 3 participants receiving gentamicin had an allergic reaction; no abnormal increases in IOP were detected in any group (Shulman 1982) 1 additional study reported that 1 participant in the placebo group had irritation; 5 participants ended the study with inferior epithelial keratitis; no difference in IOP between groups (Jackson 1982) |
*
Of the studies that compared topical antibiotics with placebo 6/7 reported overall clinical outcomes; 4/7 reported outcomes for signs and 3/7 reported outcomes for symptoms separately; 6/7 reported bacteriologic outcomes; and 6/7 reported adverse outcomes. Treatment effects in bold were statistically significant.
95% CI: 95% confidence interval
IOP: intraocular pressure
IV, Fixed: generic inverse variance method, fixed-effect model
MGD: meibomian gland dysfunction
M-H, Fixed: Mantel-Haenszel method, fixed-effect model
RR: risk ratio
VAS: visual analog scale