title: Efficacy of Carboxymethylcellulose and Hyaluronate in Dry Eye Disease: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  The efficacy of two artificial tears, carboxymethylcellulose (CMC) and hyaluronate (HA), was compared in the treatment of patients with dry eye disease.
  
  
  METHODS
  We conducted a systematic review and meta-analysis on randomized controlled trials in the PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases. The efficacy was compared in terms of the mean change from baseline in tear break-up time. The meta-analysis was conducted using both random and fixed effect models. The quality of the selected studies was assessed for risk of bias.
  
  
  RESULTS
  Five studies were included involving 251 participants. Random effect model meta-analysis showed no significant difference between CMC and HA in treating dry eye disease (pooled standardized mean difference [SMD]=-0.452; 95% confidence interval [CI], -0.911 to 0.007; P=0.053). In contrast, fixed effect model meta-analysis revealed significant improvements in the CMC group when compared to the HA group (pooled SMD=-0.334; 95% CI, -0.588 to -0.081; P=0.010).
  
  
  CONCLUSIONS
  The efficacy of CMC appeared to be better than that of HA in treating dry eye disease, although meta-analysis results were not statistically significant. Further research is needed to better elucidate the difference in efficacy between CMC and HA in treating dry eye disease.
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Jae Kyeong
authors.initials: JK
authors.lastname: Song
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Kiheon
authors.initials: K
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Hwa Yeon
authors.initials: HY
authors.lastname: Park
authors.affiliation: Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Hyon
authors.affiliation: Department of Family Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
authors.forename: Seung-Won
authors.initials: SW
authors.lastname: Oh
authors.affiliation: Department of Family Medicine, Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Woo Kyung
authors.initials: WK
authors.lastname: Bae
authors.affiliation: Department of Family Medicine, Health Promotion Center, Seoul National University Bundang Hospital, Seongnam, Korea.
authors.forename: Jong-Soo
authors.initials: JS
authors.lastname: Han
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Se Young
authors.initials: SY
authors.lastname: Jung
authors.affiliation: Department of Family Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
authors.forename: Yoo Jin
authors.initials: YJ
authors.lastname: Um
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ga-Hye
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Ji Hye
authors.initials: JH
authors.lastname: Yang
keywords: Carboxymethylcellulose Sodium; Fluorescein Tear Breakup Time; Hyaluronate; Xerophthalmia