PONE-D-23-26616Effects of Traditional Chinese medicine  in the treatment of patients with central serous chorioretinopathy: a systematic review and meta-analysisPLOS ONE

Dear Dr. Sun,

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Tungki Pratama Umar, M.D.

Academic Editor

PLOS ONE

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4. Thank you for stating in your Funding Statement: 

"This work was supported by “Major Research Project of Acupuncture and Moxibustion Clinical Discipline, Science and Technology Innovation Project, Chinese Academy of Traditional Chinese Medicine” (No. C12021A03513) and “Independent Selection Project of Chinese Academy of Traditional Chinese Medicine” (No. ZZ16-XRZ-024)."

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Additional Editor Comments:

Abstract

1. Overall abstract should be rewritten. Use non-structured abstract.

2. Introduction should have more background regarding study importance or motive

3. Methods: Add more about inclusion criteria, used databases, PRISMA adherence, type of meta-analysis, etc

4. Define abbreviations written in it

Introduction

1. Add more information about treatment and prevention of the disease, and why TCM is used

2. Overall, it is still confusing, why only writing bad side of the intervention? Please add more information, especially it is commonly inferred that SR/MA is intended for searching potential treatment/favorable effect (which is also apparent in the authors’ abstract)

Methods

1. For inclusion criteria, write it as narrative (as the exclusion criteria)

2. How about treatment outside of TCM? Is it considered as exclusion criteria or not? Please elaborate more about it

3. “Case series reports” are misleading term, please correct it to case series or case reports

4. Add no full text as exclusion criteria

5. Databases with abbreviation should be written as long form in first occurrence

6. Data extraction: add what data the authors wanted to gather

7. Add initials of all reviewer, not just write one or two

8. Add citation for RevMan (RevMan 5.4.1 (Cochrane Collaboration)

9. Delete “according to the synthesis without the meta-analysis guideline.”

10. Describe reviewers’ credentials for GRADE (are they ophthalmologists, TCM practitioners, or what?)

11. Rewrite and recite all PRISMA (mandatory). The authors were using an outdated version of it (2009). Should use 2020 version.

Result

1. Add criteria about acute and chronic CSC (suggestion: locate in method, data extraction)

2. ROB was used to evaluate the risk of bias in 23 RCTs [10,11,18,20] � but this is only 4 studies?

3. I am not really sure about the association about “funding” that is mentioned in the result (suggestion: delete)

4. Where is GRADE? Not shown in the result

5. For publication bias, do the analysis (e.g. Egger test) to determine whether there is a true bias. If it stays, give more explanation about the possible source.

Discussion

1. Expand discussion section, mostly by giving more detailed explanation about why TCM is beneficial while CS is usually not. Add more substances that may be responsible for it (not only giving general mechanism).

General

1. Please recheck for grammar and typographic error (such as: backgroud)

2. The information is interesting. However, there are several inconsistencies that may hinder further processing of this manuscript.

[Note: HTML markup is below. Please do not edit.]

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

Reviewer #2: Yes

Reviewer #3: Partly

Reviewer #4: Yes

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2. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: No

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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3. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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4. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #3: Yes

Reviewer #4: Yes

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5. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: 1. The authors should include name of Traditional Chinese medicine (TCM) that used in this study, such as wolfberry, licorice etc

2. The authors should clarify the kind of the TCM

"Single TCM such as: wolfberry, etc or combination of the TCM such as: wolfberry + licorice etc"

3. The study is lack of information about the safety of the TCM which is the one of the objective in this study

4. The authors must provide an explanation regarding treatment with TCM + C and TCM alone to avoid data bias

Reviewer #2: Dear authors,

Stress and cortisol are well-established factors in the pathogenesis of CSC. A meta-analysis on the effects of Chinese traditional medicine with purported hormone-like effects is therefore a relevant and interesting topic. I hope my comments will be helpful to further improve the manuscript.

Page 5: In the data analysis section, there is a typographical error regarding CSC type. Chornic is greater than 6 months and acute should be less than 6 months. Also in the next line, ‘no treatment, et al’ seems to be an error.

Page 6: In literature search, please recheck the number of duplicate studies that were removed (995). A total of 1826 articles and 838 remaining, does not match with it. Also, the number of full text articles excluded (321) needs to be rechecked in figure 1.

Page 7: Please mention the hormone-like and non-hormone-like herbal medicines that were used in the included studies. Also what were the vitamins and retinal microcirculation-improving drugs?

Page 11: The mixed type CSC is mentioned. However, the definition is not included in the methods/data analysis. Does it mean CSC in combination with RPE detachments, neovascularization, etc?

Reviewer #3: Although a good review, the reviewer feels that it does not add anything new in the literature.

Maybe focusing on a selected TCMs and looking in depth at the effect of the selected TCMs might be more useful. As it stands it is too broad and unfocused.

Reviewer #4: This manuscript reported meta-analysis results about the efficacy and safety of treatments with Traditional Chinese medicine added in treating patients with Central serous chorioretinopathy (CSC). PRISMA guideline is followed. Subgroup analysis and many sensitivity analysis were performed for scientific rigor. However, there are some concerns:

1. It is unclear if all analysis had treated two eyes from the same patient as independent. For example, # of events and # of totals in Figure 2 and Figure 5 are on the patient-level or the eye-level? If those are on the eye-level, the calculation of corresponding OR should take into account the dependence of both eyes from the same patient. Similar concern for the estimation of mean differences exists.

2. It is unclear how standard mean difference is defined for BCVA where 18 studies used a standard visual acuity chart (decimal) and 2 used a logarithmic visual acuity chart (5-point scale). More details should be given.

3. It is recommended that the study team gets a professional biostatistician's help in result explanation. For example, the abstract says " it has no obvious side effects (OR=0.82, 95% CI:0.44,1.52; I2 = 30%)." which should be corrected because the quoted OR only suggested that TCM had no significantly different risk of side effect compared with the control group. Also it is claimed that "This study shows that the use of TCM does not cause the recurrence of CSC" which is not a rigorous statement.

4. Section 2.2.4 listed two primary outcomes. So it is recommended to report 97.5%CI for each primary outcome instead of 95% CIs.

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Reviewer #1: No

Reviewer #2: No

Reviewer #3: No

Reviewer #4: No

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Effects of Traditional Chinese Medicine  in the treatment of patients with central serous chorioretinopathy: a systematic review and meta-analysis

PONE-D-23-26616R1

Dear Dr. Sun,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Tungki Pratama Umar, M.D.

Academic Editor

PLOS ONE

Additional Editor Comments (optional):

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: All comments have been addressed

Reviewer #2: All comments have been addressed

Reviewer #4: All comments have been addressed

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #4: Yes

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #4: Yes

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

Reviewer #2: (No Response)

Reviewer #4: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: Yes

Reviewer #2: Yes

Reviewer #4: Yes

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: (No Response)

Reviewer #2: (No Response)

Reviewer #4: All my previous comments have been fully addressed. There is no additional comment from me and I recommend acceptance of this paper.

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7. PLOS authors have the option to publish the peer review history of their article (what does this mean?). If published, this will include your full peer review and any attached files.

If you choose “no”, your identity will remain anonymous but your review may still be made public.

Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy.

Reviewer #1: No

Reviewer #2: No

Reviewer #4: No

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