Comparative efficacy of regenerative strategies versus traditional anti-inflammatory agents for moderate-to-severe dry eye disease: A systematic review and Bayesian network meta-analysis.

PURPOSE: To compare the efficacy of regenerative therapies and conventional anti-inflammatory treatments for moderate-to-severe dry eye and provide evidence for clinical decision-making.

METHODS: PubMed, Cochrane Library, and Embase were systematically searched. Only randomized controlled trials were included. A network meta-analysis compared platelet-rich plasma (PRP), autologous serum (AS), stem cells, 0.05% cyclosporine A, and 0.1% cyclosporine A using OSDI, NIKBUT first, CFS, and Schirmer test outcomes. Evidence certainty was assessed with CINeMA.

RESULTS: Twenty-one randomized controlled trials were included. PRP showed greater improvement in symptoms and tear secretion, with an OSDI MD of -24.89 and Schirmer test MD of 2.73. AS performed better in tear film stability and corneal epithelial repair, with a NIKBUT first MD of 2.13 and CFS MD of -1.50. Stem cells and cyclosporine A generally showed less favorable effects across most outcomes. However, confidence intervals were wide for several comparisons, and certainty of evidence varied.

CONCLUSION: PRP and AS may be more effective than stem cells and cyclosporine A for moderate-to-severe dry eye, but their advantages differ by outcome. PRP may be preferred for symptom relief and tear secretion, whereas AS may better improve tear film stability and corneal staining. Clinical application should consider patient characteristics, target outcomes, and evidence certainty.