An evidence mapping study based on systematic reviews of TCM for diabetic retinopathy

An evidence mapping study based on systematic reviews of TCM for diabetic retinopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article An evidence mapping study based on systematic reviews of TCM for diabetic retinopathy Ling Juan, Zhuo-Lin Xie, Xiang-Xia Luo, Mei Hu, Demián Glujovsky, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4457677/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 20 Feb, 2025 Read the published version in Systematic Reviews → Version 1 posted 5 You are reading this latest preprint version Abstract Background: Diabetic retinopathy (DR) is a severe microvascular complication of diabetes mellitus, posing a significant risk of vision impairment and blindness among the diabetic population. With the global prevalence of diabetes rising, the burden of DR is expected to increase, necessitating effective prevention and treatment strategies. Traditional Chinese Medicine (TCM) has been increasingly explored as a complementary and alternative treatment for DR. Systematic reviews have been conducted to evaluate the efficacy and safety of TCM interventions for DR, but the evidence remains scattered and varied in quality. An evidence mapping study can provide a comprehensive overview of the available systematic reviews, identify gaps in the evidence, and highlight areas needing further research, thereby informing clinical practice and guiding future research endeavors in the field of TCM for diabetic retinopathy. Objective: This study aims to evaluate the reporting and methodological quality of systematic reviews (SRs) investigating the use of Traditional Chinese Medicine (TCM) for the treatment of diabetic retinopathy (DR), and to analyze the effectiveness, methodological quality, and classification of TCM treatment methods for DR using an evidence-mapping approach. Methods: A comprehensive literature search was conducted in major biomedical databases to identify relevant SRs published up to November 2023. The reporting quality of the included SRs was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while the methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool. Results: A total of 51 SRs, encompassing 131,084 participants, met the eligibility criteria and were included in the analysis. The evidence mapping indicated that TCM is a relatively effective therapy for treating DR. However, the quality of the methodology and reporting in these SRs was suboptimal. The analysis revealed that while many SRs satisfied key AMSTAR criteria, significant methodological shortcomings were present, such as insufficient information on funding, lack of lists of excluded studies, and absence of pre-specified protocols. Furthermore, common reporting deficiencies included incomplete protocol and registration details, unexplained review rationales, and insufficient relevant outcome data from other analyses. Conclusion: TCM appears to be a relatively effective therapy for treating DR. However, the reporting and methodological quality of SRs on TCM for DR is generally low, highlighting the need for improvement and more high-quality evidence. Future SRs should strive to adhere to established reporting guidelines, address the identified methodological weaknesses, and enhance the overall quality of evidence regarding TCM interventions for DR. Adhering to PRISMA and AMSTAR 2 guidelines is essential to improve the quality of future SRs. Traditional Chinese Medicine systematic review AMSTAR 2 PRISMA Evidence mapping diabetic retinopathy Figures Figure 1 Figure 2 Figure 3 Figure 4 1. Introduction The increasing prevalence of diabetes has become a pressing public health challenge that demands immediate attention. Current statistics indicate that 537 million adults worldwide are living with diabetes, a figure that is cause for significant concern. The medical expenses related to diabetes have skyrocketed to $ 850 billion, imposing an enormous economic burden on society. Furthermore, China has the highest prevalence of diabetes globally, and diabetic retinopathy (DR) has emerged as a severe complication of the illness, presenting a significant public health problem. Traditional Chinese Medicine (TCM) has gained attention as a complementary and alternative therapy for the management of DR. In recent years, there has been a notable increase in the number of published systematic reviews (SRs) and meta-analyses focusing on the efficacy of TCM for treating DR. SRs play a crucial role in summarizing the available evidence regarding the effectiveness and safety of TCM interventions for DR. By systematically collecting and analyzing all relevant studies, SRs can provide evidence-based recommendations for clinical decision-making with a high level of confidence. High-quality SRs can minimize bias and offer a more accurate assessment of an intervention's effectiveness. However, the reporting and methodological quality of these SRs have not been thoroughly evaluated. Ensuring the high reporting quality of studies is critical to guarantee that all relevant information on study design, interventions, outcomes, and potential biases is accurately reported. By thoroughly evaluating the methodological quality of a review process, we can gain insights into its rigor and robustness, including study selection, data extraction, and statistical analysis. Evidence mapping (EM) is a research method that rapidly collects and evaluates existing evidence on a particular topic. EM provides a visual overview of existing evidence and identifies gaps in knowledge that require further research. This approach allows decision-makers to make informed decisions about patient care and helps avoid the wastage of academic resources. Therefore, this study aims to evaluate the reporting and methodological quality of SRs investigating TCM interventions for DR, and to analyze the effectiveness, methodological quality, and classification of TCM treatment methods for DR using an EM approach. 2. Methods 2.1. Literature Search A comprehensive literature search was conducted to identify relevant systematic reviews (SRs) and meta-analyses on the treatment of diabetic retinopathy (DR) using Traditional Chinese Medicine (TCM). The search included PubMed, Embase, Cochrane Library, Web of Science, CBM, WanFang Data, CNKI, and CQVIP from their inception to November 2023. Both Medical Subject Headings (MeSH) and free-text terms were used, including "Traditional Chinese Medicine," "diabetic retinopathy," "Meta-Analysis," and "Systematic Review." The detailed search strategy is listed in “Supplementary File Table 1 ,” and was adapted with Chinese terms for the Chinese electronic databases. 2.2. Inclusion and Exclusion Criteria The inclusion criteria were: (1) Patients diagnosed with DR, with no restrictions on gender, age, or nationality; (2) Interventions involving traditional Chinese medicine or a combination of traditional Chinese and Western medicine; (3) Comparators including conventional Western medicine, placebo, or blank control; and (4) Study designs consisting of SRs and meta-analyses of randomized controlled trials. Excluded were duplicates, protocols, reviews, comments, conference abstracts, and animal studies. 2.3. Study Selection and Data Extraction Two reviewers (J Ling and ZL X) independently conducted the screening and data extraction. Disagreements were resolved by consulting a third reviewer. EndNote X20 software (Thomson Corporation, Stamford, CT) was used to identify and remove duplicates efficiently. Titles and abstracts of the selected studies were meticulously screened, followed by a thorough review of the full texts to ensure only the most relevant and high-quality studies were included. Data extracted included details on the first author, publication date, methodological quality assessment tool, intervention methods, control measures, outcome measures, number of included studies, total number of patients, year of publication, treatment methods of TCM for DR, and the number of original studies included in the SRs. 2.4. Quality Assessment Two reviewers independently assessed the methodological quality of the included SRs using the AMSTAR 2 (Assessment of Multiple Systematic Reviews 2) tool. AMSTAR 2 comprises 16 items, each assessed as "Yes" (criterion explicitly met), "Partial Yes" (item relevant but not fully described), "No" (criterion explicitly not met), or "No meta-analysis conducted." The assessment was carried out online via https://amstar.ca/Amstar_Checklist.php , which generated overall quality assessments ("Critically low," "Low," "Moderate," or "High"). The results were analyzed using R software (R-4.3.2). Additionally, the quality of reviews was independently assessed using the 27-item PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Disagreements were resolved through consensus and discussion with a third reviewer. Compliance below 50% with PRISMA and AMSTAR 2 guidelines indicated a substantial need for improvement in both the reporting and methodological quality of the SRs. 2.5. Evidence Mapping Currently, there are no established reporting guidelines or methodological standards for Evidence Mapping (EM). Therefore, we utilized the Global Evidence Mapping methodology and previous research on EM and evidence and gap map methodology to guide our study. These methodologies were expanded and refined through extensive discussion among all authors. We employed a bubble plot to present information in four dimensions. Each bubble represents one SR, with the bubble size indicating the number of original studies included. The X-axis represents the effectiveness of TCM in treating DR, and the different bubble colors represent different treatments. The Y-axis represents the methodological quality of the SRs. The bubble chart was created using the online evidence mapping tool available on the Pymeta.com website ( https://www.pymeta.com/evdmap/ ), effectively displaying the key features of the studies. 3. Results 3.1 Study Identification A total of 201 records were identified through our search. After removing duplicates, 139 records remained for screening. Following the screening of titles and abstracts, 83 records were excluded. The full text of the remaining 56 records was retrieved for further scrutiny. Of these, 5 were excluded for not meeting the eligibility criteria. Ultimately, 51 systematic reviews (SRs) were included in this overview. The study selection process is summarized in Figure 1. 3.2 Characteristics of Included SRs The general characteristics of the population, interventions, and comparison groups included in the 51 systematic reviews (SRs) are summarized in Table 1. Among the 51 SRs, involving a total of 131,084 patients, 12 articles (23.5%) were published in English, while the remaining 39 studies (76.5%) were published in Chinese. The publication years of these SRs ranged from 2013 to 2023. The control groups in these studies received conventional Western medicine, placebo, or no treatment, while the treatment groups received either pure Chinese medicine or a combination of traditional Chinese and Western medicine. Specifically, 20 studies (39.2%) utilized Chinese herbal medicine, 2 studies (3.9%) used Chinese herbal extracts, 2 studies (3.9%) employed integrated traditional Chinese and Western medicine, 26 studies (51%) used traditional Chinese patent medicines and simple preparations, and 3 studies (5.9%) utilized acupuncture and moxibustion. All included studies underwent rigorous methodological quality evaluation. Of these, 42 studies (82.4%) were assessed using the Cochrane risk of bias tool, and 9 studies (17.6%) were evaluated using the Jadad scale. Table1. Basic characteristics of included studies Study ID Studies included(n) Samples(n) Treatments Quality evaluation tools Experimental group Control group Tian XC,2023 [17] 38 3880 Chinese patent drug Usual care ROB Liu ZQ,2023 [18] 42 10836 Chinese patent drug+Control Calcium Dobesilate ROB Li HD,2023 [19] 107 9710 TCM+Control Western medicine ROB Huai BG,2023 [20] 18 1392 TCM+Control Usual care ROB Du JA,2023 [21] 7 835 Shuangdan Mingmu Capsules+Control Usual care ROB Xu ZH,2023 [22] 18 1801 TCM+acupuncture Western medicine ROB Wang SQ,2023 [23] 15 1925 Western medicine+CDDP Western medicine ROB Pang QB,2023 [24] 18 1487 Yishen Yangyin Huoxue Method+Control Western medicine ROB Li H,2023 [25] 28 3290 Compound Xueshuantong+Control Calcium Dobesilate ROB Hou XY,2023 [26] 20 2263 Yishen Huoxue Method+Control Calcium Dobesilate+Western medicine ROB Gao K,2023 [27] 42 3532 Yishen Yangyin Huoxue Method Western medicine ROB Ding S,2023 [28] 6 365 Compound Rutin Tablets/Shihu Night Light Pills+Control Usual care ROB Zhang YH,2022 [29] 19 3190 Calcium Dobesilate+Control Calcium Dobesilate ROB Wang Y,2023 [30] 26 2047 CDDP Usual care/placebo Jadad Scale Sun W,2022 [31] 45 9503 TCM Usual care ROB Li XD,2022 [32] 27 2144 TCM+Control Usual care ROB Zhao SY,2022 [33] 19 1549 Integrated Traditional Chinese and Western Medicine Western medicine ROB Li HD,2022 [34] 14 1299 Calcium Dobesilate+qi ming granule+Control Usual care+Calcium Dobesilate ROB Hu ZY,2022 [35] 17 1379 Huoxue Huayu Method+Control Calcium Dobesilate ROB Duan JN,2022 [36] 32 4852 TCM+Control Anti VEGF+Laser photocoagulation surgery ROB Hu ZP,2021 [37] 16 － qi ming granule+Control placebo/Usual care ROB Xu JY,2021 [38] 15 1145 acupuncture Western medicine+TCM ROB Liu WQ,2021 [39] 10 180 acupuncture+TCM Usual care ROB Pang B,2020 [40] 33 3430 Huoxue Huayu Method+Control Usual care/placebo ROB An XD,2020 [41] 18 1522 TCM+Control Western medicine ROB Yang XR,2020 [42] 13 1250 TCM+Control Western medicine ROB Wang MR,2020 [43] 24 2601 CDDP+Control Calcium Dobesilate/placebo ROB Su MG,2020 [44] 14 1664 qi ming granule Usual care Jadad Scale Cheng JJ,2020 [45] 19 1778 Compound thrombosis capsule+Control Calcium Dobesilate ROB Ou C,2019 [46] 10 661 Yiqi Yangyin Method+Control Western medicine ROB Zhou LJ,2019 [47] 29 2820 qi ming granule placebo ROB Qu C,2019 [48] 12 1735 Daming Yin+Control Usual care+Calcium Dobesilate ROB Gui P,2019 [49] 8 688 qi ming granule Calcium Dobesilate ROB Guan MD,2019 [50] 8 628 acupuncture Usual care ROB Chen BM,2019 [51] 13 1268 Compound thrombosis capsule+Control Calcium Dobesilate ROB Zhang N,2018 [52] 43 3875 Mingmu Tang+Control Calcium Dobesilate ROB Qu C,2018 [53] 9 1082 Xuefu Zhuyu Decoction+Control Usual care ROB Ou C,2018 [54] 10 723 TCM Western medicine ROB Ning SY,2018 [55] 39 4800 Huoxue Huayu Method Usual care+Calcium Dobesilate ROB Huang SW,2018 [56] 17 1756 TCM placebo/Calcium Dobesilate ROB Gao MZ,2018 [57] 72 6165 TCM+Laser photocoagulation surgery Laser photocoagulation surgery Jadad Scale Yan XY,2017 [58] 56 8670 TCM placebo/Western medicine ROB Wang F,2017 [59] 62 5180 TCM Calcium Dobesilate+Western medicine Jadad Scale Ning SY,2017 [60] 10 1522 ligustrazine+Control Usual care Jadad Scale Chen QY,2017 [61] 26 2421 TCM+Control Calcium Dobesilate ROB Zhu T,2015 [62] 17 1050 CDDP Dobess/Qiju Dihuang Pills/placebo/Inosine Tablets Jadad Scale Si JK,2014 [63] 6 759 qi ming granule blank group/usual ROB Lin J,2014 [64] 6 1346 Compound thrombosis capsule+Control Usual care+Laser photocoagulation surgery ROB Shen GH,2014 [65] 9 1076 Compound thrombosis capsule+Control Usual care Jadad Scale Hu R,2013 [66] 8 550 puerarin injection+Control Usual care Jadad Scale Gao J,2013 [67] 14 1460 Integrated Traditional Chinese and Western Medicine Western medicine Jadad Scale Note：－：unreported 3.3 Assessment of Quality of Included SRs 3.3.1 Methodological Quality of Included SRs The methodological quality of the 51 included studies was assessed using the AMSTAR 2 checklist (Supplementary File Table 2). As shown in Figure 2, one SR (2%) was of high quality, 29 SRs (56.9%) were of moderate quality, 20 SRs (39.2%) were of low quality, and one SR (2%) was of critically low quality. All studies fully reported on item 1 (PICO: populations, interventions, comparisons, and outcomes), item 9 (techniques for assessing the risk of bias), and item 11 (appropriate methods for the statistical combination of results). None of the included studies provided any information for item 10 (funding sources of the included studies), only one study (2%) addressed item 7 (a list of excluded studies and reasons for their exclusion), eight SRs (15.7%) discussed item 2 (whether a pre-specified protocol was developed before conducting the SRs), and 20 SRs (39.2%) discussed item 14 (satisfactory explanations and discussions for existing heterogeneity). Additionally, 15 SRs (29.4%) provided a complete discussion for item 4 (a comprehensive search strategy), and five SRs (9.8%) discussed item 8 (detailed basic information of the included studies). 3.3.2 Reporting Quality of Included SRs The findings related to the reporting quality of the SRs are displayed in Figure 3. A percentage below 50% indicates that the items had serious information missing. Out of the total number of SRs, only eight SRs (15.7%) provided protocol and registration information (item 5), while fifteen SRs (29.4%) explained the rationale for the review in the context of existing knowledge (item 3). Additionally, only eighteen SRs (35.3%) reported relevant outcomes from other analyses conducted, such as sensitivity analysis, subgroup analysis, and meta-regression analysis (item 23). More detailed information about the reporting quality of the SRs is provided in Supplementary File Table 3. 3.4 Evidence Mapping The methodological quality and evidence of TCM for diabetic retinopathy were evaluated using a bubble plot (Figure 4). The overall methodological quality of the included SRs ranged from moderate to low. Specifically, 20 SRs were classified as low quality, while 29 SRs were classified as moderate quality. In terms of outcome indicators, 48 studies were classified as beneficial, 2 studies were classified as potentially beneficial, and 1 study was classified as unclear. Regarding the classification of TCM treatment methods for DR, the studies were categorized as follows: 18 studies focused on promoting blood circulation (Huoxuefa), 17 studies focused on tonifying (Buyifa), 14 studies focused on removing blood stasis (Huayufa), 5 studies focused on unblocking collaterals (Tongluofa), and 4 studies mentioned other treatment methods. 4. Discussion In recent years, Traditional Chinese Medicine (TCM) has become increasingly recognized as an effective therapy for treating diabetic retinopathy (DR). Despite the rise in systematic reviews (SRs) related to TCM for DR, the quality of their reporting and methodology remains uncertain. This mapping study was conducted to assess the reporting and methodological quality of SRs on TCM for DR published from 2013 to 2023. Our findings suggest that while TCM shows promise as a therapy for DR, the quality of the methodology and reporting in these SRs is often unsatisfactory. The AMSTAR 2 tool was used to assess various aspects of the methodological quality of the included SRs, revealing several areas needing improvement: 1. Funding Information (Item 10) : Many included studies did not elaborate on the funding information of the included research. Research projects funded by commercial sources may lead to biased conclusions related to the products of the supporting parties. Therefore, researchers must publicly disclose funding sources or explain the status of undisclosed funding sources to evaluate the study's results accurately . Future studies need to strengthen the explanation of funding sources to ensure the scientific and transparent nature of the research results. 2. List of Excluded Studies (Item 7) : Most included studies did not provide a list of excluded studies along with the reasons for their exclusion. Providing such a list can help ensure the accuracy of study selection and has been recommended by other researchers . A clear and detailed description of excluded studies is essential to validate the overall study selection process. 3. Pre-specified Protocol (Item 2) : Many studies did not provide a detailed explanation of the relevant content of developing a preliminary research protocol before conducting a systematic review. Establishing a research protocol before conducting a systematic review or meta-analysis is crucial to minimize bias in evaluation results. Registering the protocol with platforms such as PROSPERO or publishing it in a journal promotes transparency and reduces bias in the reported results . The compliance with items 3, 5, and 23 in the included SRs was less than 50%, indicating significant gaps in reporting quality. Only eight SRs disclosed the applied protocol and registration information. Properly designing and registering the protocol for SRs/MAs as soon as possible is essential to avoid reporting bias. Additionally, describing the review's rationale in the context of existing knowledge and providing a clear statement of the objectives or questions addressed by the review are crucial. Reporting relevant outcomes from other analyses, regardless of statistical significance, and indicating whether these analyses were pre-specified, are also important. In TCM research, differences in formulas and syndrome types are crucial sources of heterogeneity . Therefore, subgroup analysis based on different categories of TCM formulas and subjects with different syndrome types is recommended. Currently, Western medicine focuses primarily on oxidative stress, endothelial dysfunction, and angiogenic factors for DR treatment. Common treatments include photocoagulation, anti-VEGF drugs, steroid drugs intravitreal injection, and vitrectomy, but their effectiveness and safety are limited due to risks such as high intraocular pressure and infection from repeated injections, and unsatisfactory results from laser and vitrectomy surgeries . In contrast, TCM therapy has shown increasing therapeutic advantages in treating DR. This mapping study provides robust evidence of positive results, with 94.1% of the studies classified as beneficial. This finding is significant in the fight against DR and offers hope for those suffering from the condition. Notably, some studies have shown that TCM extracts, such as ginsenoside Rg12, can have a protective effect on retinopathy in mice with type 2 diabetes . Strengths and Limitations This mapping study is the first to assess the methodological quality of SRs using the AMSTAR 2 and PRISMA tools to evaluate the quality of evidence for the efficacy of TCM in DR patients. However, our study has some limitations. We included only SRs or meta-analyses, while primary studies (such as cohort studies, observational studies, and case–control studies) were not reviewed. 5 Conclusion The evidence presented strongly suggests that TCM therapy is an effective treatment for DR. However, the reporting and methodological qualities of the related SRs are not high. To ensure the highest quality of clinical research guidance, we highly recommend utilizing the AMSTAR 2 tool and PRISMA checklist. These tools will help improve the quality of research and provide effective evidence-based medicine for clinical guidance. Declarations Compliance with Ethical Standards Consent for Publication All participants consented to publication of the results of this study. Conflict of Interest We have no conflicts of interest that are directly relevant to the content of this article. Funding This study was funded by Gansu Province Health Industry Research Program Project (GSWSKY2022-44); Gansu Provincial Hospital Internal Medicine Research Fund Project Funding (23GSSYF-9); National Natural Science Foundation of China (81960888); National Natural Science Foundation of China (82360955) Availability of data and material Not applicable. Author Contributions All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by LJ, XZL, DG, WY, ZYH and ZJ. 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Shi Yan Systematic evaluation on acupuncture treatment of diabetes retinopathy [J]. J Liaoning Univ Traditional Chin Med. 2019;21(02):114–7. Chen Bomian L, Yuling W, Dongcai Z, Hengxia, Li H. Systematic evaluation of compound Xueshuantong combined with calcium dobesilate in the treatment of diabetes retinopathy [J]. Tianjin Traditional Chin Med. 2019;36(04):378–83. Zhang N. Meta analysis of traditional Chinese medicine in the treatment of non proliferative diabetes retinopathy and clinical efficacy observation of. Mingmu Decoction [D] Master's degree; 2018. Qu Chao Y, Yufeng N, Shunyu G, Mingdan. Shi Yan Meta analysis of Xuefu Zhuyu Decoction in the treatment of diabetes retinopathy [J]. J Liaoning Univ Traditional Chin Med. 2018;20(09):184–8. Chen O, Xiaofang P, Yinxin L, Huiyu Q, Xiangdong C, Qinghua P. Meta analysis of the efficacy of traditional Chinese medicine in the treatment of diabetes retinopathy after photocoagulation [J]. J Hunan Univ Traditional Chin Med. 2018;38(12):1407–11. Ning Shunyu. Meta analysis and GRADE evaluation of the clinical efficacy of promoting blood circulation and removing blood stasis in the treatment of diabetes. retinopathy [D] Master's degree; 2018. Huang Shuwen L, Suhuan Y, Shuyu. Meta analysis of the efficacy of traditional Chinese medicine in the treatment of diabetes retinopathy [J]. J Clin Chin Med. 2018;30(01):77–82. Gao, Meizi. Meta analysis of the comparison of the efficacy of traditional Chinese medicine combined with laser photocoagulation and laser photocoagulation alone in the treatment of diabetes retinopathy [. D] Master's degree Tianjin University of Traditional Chinese Medicine; 2018. Xiaoyi Y, Liyan J, Nanqi Z, Zhaolan L. Systematic evaluation of the safety of traditional Chinese medicine in the treatment of diabetes retinopathy [J]. J Pharmacoepidemiology. 2017;26(03):153–61. Wang F, Hualing S, Yanyun M, Jingjing T, Yiyi Z, Dian Z, Jin Z, Rong S. Meta analysis of the treatment of non proliferative diabetes retinopathy with traditional Chinese medicine [J]. Chin J Experimental Formula Stud. 2017;23(15):202–10. Ning Shunyu G, He Y, Yufeng. Shi Yan Systematic evaluation of ligustrazine combined with medication in the treatment of diabetes retinopathy [J]. Chin J Traditional Chin Med. 2017;35(09):2421–6. Chen Qiuye M, Yanyun T, Hong. Meta analysis of the influence of traditional Chinese medicine treatment on hemorheological indicators in patients with diabetes retinopathy [J]. China Med J. 2017;14(21):175–84. Zhu, Tao. Dai Xiaohua Meta analysis of compound Danshen dropping pills in the treatment of diabetes retinopathy [J]. J Anhui Univ Traditional Chin Med. 2015;34(02):15–9. Si Junkang G, Junguo B, Hongsheng T, Kai D, Yuxiang G, Dadong W. Systematic evaluation of Qiming Granule in the treatment of diabetes retinopathy [j]. Chin J Practical Ophthalmol. 2014;32(9):1125–9. Lin Jia T, Ran L, Xiang Z, Li M, Ning. Shang Hongcai Systematic evaluation of the efficacy and safety of compound Xueshuantong capsule combined with laser in the treatment of diabetes retinopathy [J]. Tianjin Traditional Chin Med. 2014;31(10):591–5. Shen Guohong Systematic analysis. of compound Xueshuantong capsule in the treatment of diabetes retinopathy [J]. China Traditional Chin Med Technol. 2014;21(05):591–2. Rui H, Yanbin L. Zhang Enhu: Systematic review of puerarin injection in the treatment of diabetes retinopathy Traditional Chinese patent medicines and simple preparations, 2013, 35 (7): 1407–10. Gao Jing W, Fenghua Z, Lixia. Meta analysis of the effect of integrated traditional Chinese and western medicine on diabetes retinopathy [J]. Western Med. 2013;25(05):767–71. Ge L, Bei P, Jiaxue P, Yanan L, Yiting W, Shujin G, Qinghui W. Tian Jinhui Interpretation of AMSTAR-2- A Quality Evaluation Tool Based on Randomized and/or Non Randomized Controlled Trial System Evaluation [J]. Chin Drug Evaluation. 2017;34(05):334–8. Sun Wenyu Z, Xueqin G, Yujie, Deng Hongyong Evidence atlas analysis of TCM intervention in diabetes retinopathy [J] Chinese Journal of Traditional Chinese Medicine, Ge L, Tian JH, Li YN et al. (2018) Association between prospec tive registration and overall reporting and methodological qual ity of systematic reviews: a meta-epidemiological study. J Clin Epidemiol 93:45–55. https://doi.org/10.1016/j.jclinepi.2017.10. 012 . Kelly SE, Moher D, Cliford TJ. Quality of conduct and reporting in rapid reviews: an exploration of compliance with PRISMA and AMSTAR guidelines. Syst Rev. 2016https://doi.org/10. 1186/s13643-016-0258-9. Li Yuxin X, Jun. Zhang Zheng, etc Interpretation of the Chinese Medicine System Evaluation/Meta Analysis Report Specification (PRISMA-CHM) [J]. Chin J Evid Based Med. 2023;23(11):1351–9. Lin KY, Hsih WH, Lin YB, et al. Update in the epidemiology, risk factors,screening, and treatment of diabetic retinopathy [J]. J Diabetes Investig. 2021;12(8):1322–5. Porta M, Striglia E. Intravitreal anti-VEGF agents and cardiovascular risk [J]. Intern Emerg Med. 2020;15(2):199–210. Li B, Dachuan Z. Li Xuewang, etc Ginsenoside Rg_1 inhibits the protective effect of NLRP3 inflammasome on retinopathy in type 2 diabetes mice [J]. Chin J Traditional Chin Med. 2022;47(02):476–83. Supplementary Files Supplementaryfile.doc Cite Share Download PDF Status: Published Journal Publication published 20 Feb, 2025 Read the published version in Systematic Reviews → Version 1 posted Reviewers agreed at journal 23 Jun, 2024 Reviewers invited by journal 22 Jun, 2024 Editor assigned by journal 19 Jun, 2024 First submitted to journal 18 Jun, 2024 Editorial decision: Major revision 16 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4457677","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":317649883,"identity":"1bb479fa-4aad-4b07-87d1-7a876cb3c90c","order_by":0,"name":"Ling 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1","display":"","copyAsset":false,"role":"figure","size":177347,"visible":true,"origin":"","legend":"\u003cp\u003eFlow chart of the literature screening process and results.\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/b013ff0a1927c037c21d0132.png"},{"id":60623375,"identity":"f79882c7-cbab-4bbf-9a08-15ea6aea915b","added_by":"auto","created_at":"2024-07-18 21:49:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":103944,"visible":true,"origin":"","legend":"\u003cp\u003eThe methodological quality of included studies\u003c/p\u003e","description":"","filename":"Figure2.png","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/69a43920310c148760fc425b.png"},{"id":60623376,"identity":"8c01a4d8-1d0b-4438-952e-51243844332e","added_by":"auto","created_at":"2024-07-18 21:49:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":263918,"visible":true,"origin":"","legend":"\u003cp\u003eThe reporting quality of the included studies\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/e386994f921d85f9ee2455cc.png"},{"id":60623379,"identity":"5a6c820b-ed8f-4107-a1b3-0fad66f9d14e","added_by":"auto","created_at":"2024-07-18 21:49:07","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":137542,"visible":true,"origin":"","legend":"\u003cp\u003eEvidence mapping of included studies\u003c/p\u003e","description":"","filename":"Figure4.png","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/99c8716b1eb0f6c16380f7e7.png"},{"id":77054324,"identity":"abe5b528-70e5-4018-9f74-3f5d919ceefb","added_by":"auto","created_at":"2025-02-24 16:31:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1309902,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/0f052c05-fd77-492e-a00a-5cad72f1e503.pdf"},{"id":60623377,"identity":"de04a8af-da84-44fc-9a45-c17b0afbcbc6","added_by":"auto","created_at":"2024-07-18 21:49:07","extension":"doc","order_by":9,"title":"","display":"","copyAsset":false,"role":"supplement","size":705168,"visible":true,"origin":"","legend":"","description":"","filename":"Supplementaryfile.doc","url":"https://assets-eu.researchsquare.com/files/rs-4457677/v1/88faa10d33a2e511da56c3c0.doc"}],"financialInterests":"","formattedTitle":"An evidence mapping study based on systematic reviews of TCM for diabetic retinopathy","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eThe increasing prevalence of diabetes has become a pressing public health challenge that demands immediate attention. Current statistics indicate that 537\u0026nbsp;million adults worldwide are living with diabetes, a figure that is cause for significant concern. The medical expenses related to diabetes have skyrocketed to \u003cspan\u003e$\u003c/span\u003e850\u0026nbsp;billion, imposing an enormous economic burden on society. Furthermore, China has the highest prevalence of diabetes globally, and diabetic retinopathy (DR) has emerged as a severe complication of the illness, presenting a significant public health problem.\u003c/p\u003e \u003cp\u003eTraditional Chinese Medicine (TCM) has gained attention as a complementary and alternative therapy for the management of DR. In recent years, there has been a notable increase in the number of published systematic reviews (SRs) and meta-analyses focusing on the efficacy of TCM for treating DR. SRs play a crucial role in summarizing the available evidence regarding the effectiveness and safety of TCM interventions for DR. By systematically collecting and analyzing all relevant studies, SRs can provide evidence-based recommendations for clinical decision-making with a high level of confidence. High-quality SRs can minimize bias and offer a more accurate assessment of an intervention's effectiveness. However, the reporting and methodological quality of these SRs have not been thoroughly evaluated. Ensuring the high reporting quality of studies is critical to guarantee that all relevant information on study design, interventions, outcomes, and potential biases is accurately reported. By thoroughly evaluating the methodological quality of a review process, we can gain insights into its rigor and robustness, including study selection, data extraction, and statistical analysis.\u003c/p\u003e \u003cp\u003eEvidence mapping (EM) is a research method that rapidly collects and evaluates existing evidence on a particular topic. EM provides a visual overview of existing evidence and identifies gaps in knowledge that require further research. This approach allows decision-makers to make informed decisions about patient care and helps avoid the wastage of academic resources. Therefore, this study aims to evaluate the reporting and methodological quality of SRs investigating TCM interventions for DR, and to analyze the effectiveness, methodological quality, and classification of TCM treatment methods for DR using an EM approach.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Literature Search\u003c/h2\u003e \u003cp\u003eA comprehensive literature search was conducted to identify relevant systematic reviews (SRs) and meta-analyses on the treatment of diabetic retinopathy (DR) using Traditional Chinese Medicine (TCM). The search included PubMed, Embase, Cochrane Library, Web of Science, CBM, WanFang Data, CNKI, and CQVIP from their inception to November 2023. Both Medical Subject Headings (MeSH) and free-text terms were used, including \"Traditional Chinese Medicine,\" \"diabetic retinopathy,\" \"Meta-Analysis,\" and \"Systematic Review.\" The detailed search strategy is listed in \u0026ldquo;Supplementary File Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e,\u0026rdquo; and was adapted with Chinese terms for the Chinese electronic databases.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Inclusion and Exclusion Criteria\u003c/h2\u003e \u003cp\u003eThe inclusion criteria were: (1) Patients diagnosed with DR, with no restrictions on gender, age, or nationality; (2) Interventions involving traditional Chinese medicine or a combination of traditional Chinese and Western medicine; (3) Comparators including conventional Western medicine, placebo, or blank control; and (4) Study designs consisting of SRs and meta-analyses of randomized controlled trials. Excluded were duplicates, protocols, reviews, comments, conference abstracts, and animal studies.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Study Selection and Data Extraction\u003c/h2\u003e \u003cp\u003eTwo reviewers (J Ling and ZL X) independently conducted the screening and data extraction. Disagreements were resolved by consulting a third reviewer. EndNote X20 software (Thomson Corporation, Stamford, CT) was used to identify and remove duplicates efficiently. Titles and abstracts of the selected studies were meticulously screened, followed by a thorough review of the full texts to ensure only the most relevant and high-quality studies were included. Data extracted included details on the first author, publication date, methodological quality assessment tool, intervention methods, control measures, outcome measures, number of included studies, total number of patients, year of publication, treatment methods of TCM for DR, and the number of original studies included in the SRs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Quality Assessment\u003c/h2\u003e \u003cp\u003e Two reviewers independently assessed the methodological quality of the included SRs using the AMSTAR 2 (Assessment of Multiple Systematic Reviews 2) tool. AMSTAR 2 comprises 16 items, each assessed as \"Yes\" (criterion explicitly met), \"Partial Yes\" (item relevant but not fully described), \"No\" (criterion explicitly not met), or \"No meta-analysis conducted.\" The assessment was carried out online via \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://amstar.ca/Amstar_Checklist.php\u003c/span\u003e\u003cspan address=\"https://amstar.ca/Amstar_Checklist.php\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e, which generated overall quality assessments (\"Critically low,\" \"Low,\" \"Moderate,\" or \"High\"). The results were analyzed using R software (R-4.3.2).\u003c/p\u003e \u003cp\u003e Additionally, the quality of reviews was independently assessed using the 27-item PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) statement. Disagreements were resolved through consensus and discussion with a third reviewer. Compliance below 50% with PRISMA and AMSTAR 2 guidelines indicated a substantial need for improvement in both the reporting and methodological quality of the SRs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Evidence Mapping\u003c/h2\u003e \u003cp\u003e Currently, there are no established reporting guidelines or methodological standards for Evidence Mapping (EM). Therefore, we utilized the Global Evidence Mapping methodology and previous research on EM and evidence and gap map methodology to guide our study. These methodologies were expanded and refined through extensive discussion among all authors.\u003c/p\u003e \u003cp\u003eWe employed a bubble plot to present information in four dimensions. Each bubble represents one SR, with the bubble size indicating the number of original studies included. The X-axis represents the effectiveness of TCM in treating DR, and the different bubble colors represent different treatments. The Y-axis represents the methodological quality of the SRs. The bubble chart was created using the online evidence mapping tool available on the Pymeta.com website (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.pymeta.com/evdmap/\u003c/span\u003e\u003cspan address=\"https://www.pymeta.com/evdmap/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e), effectively displaying the key features of the studies.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cp\u003e\u003cstrong\u003e3.1 Study Identification\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;A total of 201 records were identified through our search. After removing duplicates, 139 records remained for screening. Following the screening of titles and abstracts, 83 records were excluded. The full text of the remaining 56 records was retrieved for further scrutiny. Of these, 5 were excluded for not meeting the eligibility criteria. Ultimately, 51 systematic reviews (SRs) were included in this overview. The study selection process is summarized in Figure 1.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2 Characteristics of Included SRs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe general characteristics of the population, interventions, and comparison groups included in the 51 systematic reviews (SRs) are summarized in Table 1. Among the 51 SRs, involving a total of 131,084 patients, 12 articles (23.5%) were published in English, while the remaining 39 studies (76.5%) were published in Chinese. The publication years of these SRs ranged from 2013 to 2023.\u003c/p\u003e\n\u003cp\u003eThe control groups in these studies received conventional Western medicine, placebo, or no treatment, while the treatment groups received either pure Chinese medicine or a combination of traditional Chinese and Western medicine. Specifically, 20 studies (39.2%) utilized Chinese herbal medicine, 2 studies (3.9%) used Chinese herbal extracts, 2 studies (3.9%) employed integrated traditional Chinese and Western medicine, 26 studies (51%) used traditional Chinese patent medicines and simple preparations, and 3 studies (5.9%) utilized acupuncture and moxibustion.\u003c/p\u003e\n\u003cp\u003eAll included studies underwent rigorous methodological quality evaluation. Of these, 42 studies (82.4%) were assessed using the Cochrane risk of bias tool, and 9 studies (17.6%) were evaluated using the Jadad scale.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable1. Basic characteristics of included studies\u003c/p\u003e\n\u003cdiv align=\"\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"668\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\" rowspan=\"2\"\u003e\n \u003cp\u003eStudy ID\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\" rowspan=\"2\"\u003e\n \u003cp\u003eStudies included(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\" rowspan=\"2\"\u003e\n \u003cp\u003eSamples(n)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"49.17541229385307%\" colspan=\"2\"\u003e\n \u003cp\u003eTreatments\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\" rowspan=\"2\"\u003e\n \u003cp\u003eQuality evaluation tools\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58.84146341463415%\"\u003e\n \u003cp\u003eExperimental group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"41.15853658536585%\"\u003e\n \u003cp\u003eControl group\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eTian XC,2023\u003csup\u003e[17]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3880\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eChinese patent drug\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLiu ZQ,2023\u003csup\u003e[18]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e10836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eChinese patent drug+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLi HD,2023\u003csup\u003e[19]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e107\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e9710\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHuai BG,2023\u003csup\u003e[20]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eDu JA,2023\u003csup\u003e[21]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e835\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eShuangdan Mingmu Capsules+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eXu ZH,2023\u003csup\u003e[22]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1801\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+acupuncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eWang SQ,2023\u003csup\u003e[23]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1925\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eWestern medicine+CDDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003ePang QB,2023\u003csup\u003e[24]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1487\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eYishen Yangyin Huoxue Method+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLi H,2023\u003csup\u003e[25]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound Xueshuantong+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHou XY,2023\u003csup\u003e[26]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2263\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eYishen Huoxue Method+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate+Western medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eGao K,2023\u003csup\u003e[27]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3532\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eYishen Yangyin Huoxue Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eDing S,2023\u003csup\u003e[28]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound Rutin Tablets/Shihu Night Light Pills+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eZhang YH,2022\u003csup\u003e[29]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3190\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCalcium Dobesilate+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eWang Y,2023\u003csup\u003e[30]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2047\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCDDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care/placebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eSun W,2022\u003csup\u003e[31]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e9503\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLi XD,2022\u003csup\u003e[32]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eZhao SY,2022\u003csup\u003e[33]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1549\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eIntegrated Traditional Chinese and Western Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLi HD,2022\u003csup\u003e[34]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1299\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCalcium Dobesilate+qi ming granule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care+Calcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHu ZY,2022\u003csup\u003e[35]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1379\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eHuoxue Huayu Method+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eDuan JN,2022\u003csup\u003e[36]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e4852\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eAnti VEGF+Laser photocoagulation surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHu ZP,2021\u003csup\u003e[37]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e－\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eqi ming granule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eplacebo/Usual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eXu JY,2021\u003csup\u003e[38]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eacupuncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine+TCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLiu WQ,2021\u003csup\u003e[39]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eacupuncture+TCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003ePang B,2020\u003csup\u003e[40]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eHuoxue Huayu Method+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care/placebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eAn XD,2020\u003csup\u003e[41]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eYang XR,2020\u003csup\u003e[42]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eWang MR,2020\u003csup\u003e[43]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2601\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCDDP+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate/placebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eSu MG,2020\u003csup\u003e[44]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1664\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eqi ming granule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eCheng JJ,2020\u003csup\u003e[45]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound thrombosis capsule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eOu C,2019\u003csup\u003e[46]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e661\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eYiqi Yangyin Method+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eZhou LJ,2019\u003csup\u003e[47]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eqi ming granule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eplacebo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eQu C,2019\u003csup\u003e[48]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1735\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eDaming Yin+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care+Calcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eGui P,2019\u003csup\u003e[49]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e688\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eqi ming granule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eGuan MD,2019\u003csup\u003e[50]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e628\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eacupuncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eChen BM,2019\u003csup\u003e[51]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1268\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound thrombosis capsule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eZhang N,2018\u003csup\u003e[52]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e3875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eMingmu Tang+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eQu C,2018\u003csup\u003e[53]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1082\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eXuefu Zhuyu Decoction+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eOu C,2018\u003csup\u003e[54]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e723\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eNing SY,2018\u003csup\u003e[55]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e4800\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eHuoxue Huayu Method\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care+Calcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHuang SW,2018\u003csup\u003e[56]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eplacebo/Calcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eGao MZ,2018\u003csup\u003e[57]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e6165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Laser photocoagulation surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eLaser photocoagulation surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eYan XY,2017\u003csup\u003e[58]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e8670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eplacebo/Western medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eWang F,2017\u003csup\u003e[59]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e5180\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate+Western medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eNing SY,2017\u003csup\u003e[60]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1522\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eligustrazine+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eChen QY,2017\u003csup\u003e[61]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e2421\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eTCM+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eCalcium Dobesilate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eZhu T,2015\u003csup\u003e[62]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1050\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCDDP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eDobess/Qiju Dihuang Pills/placebo/Inosine Tablets\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eSi JK,2014\u003csup\u003e[63]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e759\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eqi ming granule\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eblank group/usual\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eLin J,2014\u003csup\u003e[64]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1346\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound thrombosis capsule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care+Laser photocoagulation surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eROB\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eShen GH,2014\u003csup\u003e[65]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1076\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eCompound thrombosis capsule+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eHu R,2013\u003csup\u003e[66]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e550\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003epuerarin injection+Control\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eUsual care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"17.09145427286357%\"\u003e\n \u003cp\u003eGao J,2013\u003csup\u003e[67]\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.193403298350825%\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"9.145427286356822%\"\u003e\n \u003cp\u003e1460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.93553223388306%\"\u003e\n \u003cp\u003eIntegrated Traditional Chinese and Western Medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20.239880059970016%\"\u003e\n \u003cp\u003eWestern medicine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"11.394302848575713%\"\u003e\n \u003cp\u003eJadad Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eNote：－：unreported\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3 Assessment of Quality of Included SRs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.1 Methodological Quality of Included SRs\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The methodological quality of the 51 included studies was assessed using the AMSTAR 2 checklist (Supplementary File Table 2). As shown in Figure 2, one SR (2%) was of high quality, 29 SRs (56.9%) were of moderate quality, 20 SRs (39.2%) were of low quality, and one SR (2%) was of critically low quality.\u003c/p\u003e\n\u003cp\u003eAll studies fully reported on item 1 (PICO: populations, interventions, comparisons, and outcomes), item 9 (techniques for assessing the risk of bias), and item 11 (appropriate methods for the statistical combination of results). None of the included studies provided any information for item 10 (funding sources of the included studies), only one study (2%) addressed item 7 (a list of excluded studies and reasons for their exclusion), eight SRs (15.7%) discussed item 2 (whether a pre-specified protocol was developed before conducting the SRs), and 20 SRs (39.2%) discussed item 14 (satisfactory explanations and discussions for existing heterogeneity). Additionally, 15 SRs (29.4%) provided a complete discussion for item 4 (a comprehensive search strategy), and five SRs (9.8%) discussed item 8 (detailed basic information of the included studies).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3.2 Reporting Quality of Included SRs\u003c/strong\u003e\u003cbr\u003eThe findings related to the reporting quality of the SRs are displayed in Figure 3. A percentage below 50% indicates that the items had serious information missing. Out of the total number of SRs, only eight SRs (15.7%) provided protocol and registration information (item 5), while fifteen SRs (29.4%) explained the rationale for the review in the context of existing knowledge (item 3). Additionally, only eighteen SRs (35.3%) reported relevant outcomes from other analyses conducted, such as sensitivity analysis, subgroup analysis, and meta-regression analysis (item 23). More detailed information about the reporting quality of the SRs is provided in Supplementary File Table 3.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.4 Evidence Mapping\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe methodological quality and evidence of TCM for diabetic retinopathy were evaluated using a bubble plot (Figure 4). The overall methodological quality of the included SRs ranged from moderate to low. Specifically, 20 SRs were classified as low quality, while 29 SRs were classified as moderate quality.\u003c/p\u003e\n\u003cp\u003eIn terms of outcome indicators, 48 studies were classified as beneficial, 2 studies were classified as potentially beneficial, and 1 study was classified as unclear. Regarding the classification of TCM treatment methods for DR, the studies were categorized as follows: 18 studies focused on promoting blood circulation (Huoxuefa), 17 studies focused on tonifying (Buyifa), 14 studies focused on removing blood stasis (Huayufa), 5 studies focused on unblocking collaterals (Tongluofa), and 4 studies mentioned other treatment methods.\u003c/p\u003e"},{"header":"4. Discussion ","content":"\u003cp\u003eIn recent years, Traditional Chinese Medicine (TCM) has become increasingly recognized as an effective therapy for treating diabetic retinopathy (DR). Despite the rise in systematic reviews (SRs) related to TCM for DR, the quality of their reporting and methodology remains uncertain. This mapping study was conducted to assess the reporting and methodological quality of SRs on TCM for DR published from 2013 to 2023. Our findings suggest that while TCM shows promise as a therapy for DR, the quality of the methodology and reporting in these SRs is often unsatisfactory.\u003c/p\u003e\n\u003cp\u003eThe AMSTAR 2 tool was used to assess various aspects of the methodological quality of the included SRs, revealing several areas needing improvement:\u003c/p\u003e\n\u003cp\u003e1.\u0026nbsp;\u003cstrong\u003eFunding Information (Item 10)\u003c/strong\u003e: Many included studies did not elaborate on the funding information of the included research. Research projects funded by commercial sources may lead to biased conclusions related to the products of the supporting parties. Therefore, researchers must publicly disclose funding sources or explain the status of undisclosed funding sources to evaluate the study\u0026apos;s results accurately . Future studies need to strengthen the explanation of funding sources to ensure the scientific and transparent nature of the research results.\u003c/p\u003e\n\u003cp\u003e2. \u003cstrong\u003eList of Excluded Studies (Item 7)\u003c/strong\u003e: Most included studies did not provide a list of excluded studies along with the reasons for their exclusion. Providing such a list can help ensure the accuracy of study selection and has been recommended by other researchers . A clear and detailed description of excluded studies is essential to validate the overall study selection process.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3. Pre-specified Protocol (Item 2)\u003c/strong\u003e: Many studies did not provide a detailed explanation of the relevant content of developing a preliminary research protocol before\u0026nbsp;conducting a systematic review. Establishing a research protocol before conducting a systematic review or meta-analysis is crucial to minimize bias in evaluation results. Registering the protocol with platforms such as PROSPERO or publishing it in a journal promotes transparency and reduces bias in the reported results .\u003c/p\u003e\n\u003cp\u003eThe compliance with items 3, 5, and 23 in the included SRs was less than 50%, indicating significant gaps in reporting quality. Only eight SRs disclosed the applied protocol and registration information. Properly designing and registering the protocol for SRs/MAs as soon as possible is essential to avoid reporting bias. Additionally, describing the review\u0026apos;s rationale in the context of existing knowledge and providing a clear statement of the objectives or questions addressed by the review are crucial. Reporting relevant outcomes from other analyses, regardless of statistical significance, and indicating whether these analyses were pre-specified, are also important. In TCM research, differences in formulas and syndrome types are crucial sources of heterogeneity . Therefore, subgroup analysis based on different categories of TCM formulas and subjects with different syndrome types is recommended.\u003c/p\u003e\n\u003cp\u003eCurrently, Western medicine focuses primarily on oxidative stress, endothelial dysfunction, and angiogenic factors for DR treatment. Common treatments include photocoagulation, anti-VEGF drugs, steroid drugs intravitreal injection, and vitrectomy, but their effectiveness and safety are limited due to risks such as high intraocular pressure and infection from repeated injections, and unsatisfactory results from laser and vitrectomy surgeries . In contrast, TCM therapy has shown increasing therapeutic advantages in treating DR. This mapping study provides robust evidence of positive results, with 94.1% of the studies classified as beneficial. This finding is significant in the fight against DR and offers hope for those suffering from the condition. Notably, some studies have shown that TCM extracts, such as ginsenoside Rg12, can have a protective effect on retinopathy in mice with type 2 diabetes .\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStrengths and Limitations\u003c/strong\u003e This mapping study is the first to assess the methodological quality of SRs using the AMSTAR 2 and PRISMA tools to evaluate the quality of evidence for the efficacy of TCM in DR patients. However, our study has some limitations. We included only SRs or meta-analyses, while primary studies (such as cohort studies, observational studies, and case\u0026ndash;control studies) were not reviewed.\u003c/p\u003e"},{"header":"5 Conclusion ","content":"\u003cp\u003eThe evidence presented strongly suggests that TCM therapy is an effective treatment for DR. However, the reporting and methodological qualities of the related SRs are not high. To ensure the highest quality of clinical research guidance, we highly recommend utilizing the AMSTAR 2 tool and PRISMA checklist. These tools will help improve the quality of research and provide effective evidence-based medicine for clinical guidance.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll participants consented to publication of the results of this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe have no conflicts of interest that are directly relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was funded by Gansu Province Health Industry Research Program Project (GSWSKY2022-44); Gansu Provincial Hospital Internal Medicine Research Fund Project Funding (23GSSYF-9); National Natural Science Foundation of China (81960888); National Natural Science Foundation of China (82360955)\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and material\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by LJ, XZL, DG, WY, ZYH and ZJ. The first draft of the manuscript was written by LJ and LXX and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Conceptualization: DHY; methodology: LJ, LXX; writing\u0026mdash;original draft preparation:LJ, XZL; writing\u0026mdash;review and editing: LJ, LXX; supervision: LXX.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eInternational Diabetes Federation. IDF Diabetes Atlas 10th edition 2021[EB/OL].2022-2-28.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTeo ZL, Tham YC, Yu M et al. Global Prevalence of Diabetic Retinopathy and Projection of Burden through 2045: Systematic Review and Meta-analysis [J].Ophthalmology, 2021, 128(11):1580\u0026ndash;91.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFaggion JC. 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Chin J Traditional Chin Med. 2022;47(02):476\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":true,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Traditional Chinese Medicine, systematic review, AMSTAR 2, PRISMA, Evidence mapping, diabetic retinopathy","lastPublishedDoi":"10.21203/rs.3.rs-4457677/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4457677/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eDiabetic retinopathy (DR) is a severe microvascular complication of diabetes mellitus, posing a significant risk of vision impairment and blindness among the diabetic population. With the global prevalence of diabetes rising, the burden of DR is expected to increase, necessitating effective prevention and treatment strategies. Traditional Chinese Medicine (TCM) has been increasingly explored as a complementary and alternative treatment for DR. Systematic reviews have been conducted to evaluate the efficacy and safety of TCM interventions for DR, but the evidence remains scattered and varied in quality. An evidence mapping study can provide a comprehensive overview of the available systematic reviews, identify gaps in the evidence, and highlight areas needing further research, thereby informing clinical practice and guiding future research endeavors in the field of TCM for diabetic retinopathy.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e This study aims to evaluate the reporting and methodological quality of systematic reviews (SRs) investigating the use of Traditional Chinese Medicine (TCM) for the treatment of diabetic retinopathy (DR), and to analyze the effectiveness, methodological quality, and classification of TCM treatment methods for DR using an evidence-mapping approach.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e A comprehensive literature search was conducted in major biomedical databases to identify relevant SRs published up to November 2023. The reporting quality of the included SRs was assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, while the methodological quality was evaluated using the Assessment of Multiple Systematic Reviews 2 (AMSTAR 2) tool.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e A total of 51 SRs, encompassing 131,084 participants, met the eligibility criteria and were included in the analysis. The evidence mapping indicated that TCM is a relatively effective therapy for treating DR. However, the quality of the methodology and reporting in these SRs was suboptimal. The analysis revealed that while many SRs satisfied key AMSTAR criteria, significant methodological shortcomings were present, such as insufficient information on funding, lack of lists of excluded studies, and absence of pre-specified protocols. Furthermore, common reporting deficiencies included incomplete protocol and registration details, unexplained review rationales, and insufficient relevant outcome data from other analyses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e TCM appears to be a relatively effective therapy for treating DR. However, the reporting and methodological quality of SRs on TCM for DR is generally low, highlighting the need for improvement and more high-quality evidence. Future SRs should strive to adhere to established reporting guidelines, address the identified methodological weaknesses, and enhance the overall quality of evidence regarding TCM interventions for DR. Adhering to PRISMA and AMSTAR 2 guidelines is essential to improve the quality of future SRs.\u003c/p\u003e","manuscriptTitle":"An evidence mapping study based on systematic reviews of TCM for diabetic retinopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-18 21:49:02","doi":"10.21203/rs.3.rs-4457677/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"","date":"2024-06-23T23:47:08+00:00","index":0,"fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-22T12:02:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-19T07:56:05+00:00","index":"","fulltext":""},{"type":"submitted","content":"Systematic Reviews","date":"2024-06-19T03:22:18+00:00","index":"","fulltext":""},{"type":"decision","content":"Major revision","date":"2024-06-16T08:01:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"systematic-reviews","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"sysr","sideBox":"Learn more about [Systematic Reviews](http://systematicreviewsjournal.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/sysr/default.aspx","title":"Systematic Reviews","twitterHandle":"@MedicalEvidence","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"cd42ee0b-f293-4a17-8b4a-eebad79978ff","owner":[],"postedDate":"July 18th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-24T16:25:02+00:00","versionOfRecord":{"articleIdentity":"rs-4457677","link":"https://doi.org/10.1186/s13643-025-02755-w","journal":{"identity":"systematic-reviews","isVorOnly":false,"title":"Systematic Reviews"},"publishedOn":"2025-02-20 15:57:39","publishedOnDateReadable":"February 20th, 2025"},"versionCreatedAt":"2024-07-18 21:49:02","video":"","vorDoi":"10.1186/s13643-025-02755-w","vorDoiUrl":"https://doi.org/10.1186/s13643-025-02755-w","workflowStages":[]},"version":"v1","identity":"rs-4457677","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4457677","identity":"rs-4457677","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}