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fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
FlorCruz, NV; Peczon, IV; Evans, JR (2012)
Publisher: Cochrane Collaboration
Languages: English
Types: Article
Subjects:
: Fungal keratitis is a fungal infection of the cornea. It is common in agricultural tropical countries but relatively uncommon in developed countries. Although there are medications available, their effectiveness is unclear.
: To examine the effect of different antifungal drugs in the management of fungal keratitis.
: We searched CENTRAL (which contains the Cochrane Eyes and Vision Group Trials Register) (The Cochrane Library 2011, Issue 8), MEDLINE (January 1950 to August 2011), EMBASE (January 1980 to August 2011), Latin American and Caribbean Literature on Health Sciences (LILACS) (January 1982 to August 2011), the metaRegister of Controlled Trials (mRCT) (www.controlled-trials.com) and ClinicalTrials.gov (www.clinicaltrials.gov). There were no date or language restrictions in the electronic searches for trials. The electronic databases were last searched on 29 August 2011.
: We included all relevant randomised controlled trials (RCTs) on medical therapy for fungal keratitis.
: Two review authors selected studies for inclusion into the review, assessed trials for risk of bias and extracted data. Interventions were compared by the proportions of participants that did not heal after a specific time of therapy. No meta-analysis was performed because the trials studied different medications with different concentrations.
: We included nine trials in this review; seven conducted in India, one in Bangladesh and one in Egypt. A total of 568 participants were randomised to the following comparisons: 1% topical itraconazole versus 1% topical itraconazole and oral itraconazole, different concentrations of silver sulphadiazine versus 1% miconazole, 1% silver sulphadiazine ointment versus 1% miconazole ointment, 2% econazole versus 5% natamycin, different concentrations of topical chlorhexidine gluconate versus 5% natamycin, 0.2% chlorhexidine gluconate versus 2.5% natamycin and voriconazole 1% versus natamycin 5%. The included trials were small and of variable quality. Differences between different regimens were not statistically different, which may reflect the low sample sizes.
: Based on the trials included in this review, there is no evidence to date that any particular drug, or combination of drugs, is more effective in the management of fungal keratitis. The trials included in this review were of variable quality and were generally underpowered.
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • NCT00516399 {published data only} NCT00516399. A clinical trial of the treatment of fungal corneal ulcers with povidone-iodine. ClinicalTrials.gov/ show/NCT00516399 (accessed 20 Sept 2011).
    • NCT00996736 {published data only} NCT00996736. Mycotic Ulcer Treatment Trial I. ClinicalTrials.gov/show/NCT00996736 (accessed 20 Sept 2011).
    • NCT00997035 {published data only} NCT00997035. Mycotic Ulcer Treatment Trial II. ClinicalTrials.gov/show/NCT00997035 (accessed 20 Sept 2011).
    • Gopinathan 2002 Gopinathan U, Garg P, Fernandes M, Sharma S, Athmanathan S, Rao GN. The epidemiological features and laboratory results of fungal keratitis: a 10 year review at a referral eye care center in South India. Cornea 2002;21(6): 555-9.
    • Higgins 2011 Higgins JPT, Altman DG, Sterne JAC (editors). Chapter 8: Assessing risk of bias in included studies. In: Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 (updated March 2011). The Cochrane Collaboration, 2011. Available from www.cochrane-handbook.org.
    • Liesegang 1980 Liesegang TJ, Forster RK. Spectrum of microbial keratitis in South Florida. American Journal of Ophthalmology 1980; 90(1):38-47.
    • O' Brien 1997 O' Brien TP, Rhee P. Pharmacotherapy of fungus infections of the eye. In: Zimmerman TJ, Koonere KS, Fecthner RD, Sharir M editor(s). Textbook of ocular pharmacology. Hagerstown: Lipincott-Raven, 1997:587-607.
    • O' Day 1996 O' Day D. Fungal keratitis. In: Pepose JS editor(s). Ocular infection and immunity. St Louis: Moseby, 1996:1048-61.
    • Review Manager 2011 The Nordic Cochrane Centre, The Cochrane Collaboration. Review Manager (RevMan). 5.1. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2011.
    • Tu 2007 Tu EY, Park AJ. Recalcitrant Beauveria bassiana keratitis: confocal microscopy findings and treatment with posaconazole (Noxafil). Cornea 2007;26(8):1008-10.
    • Valenton 2000 Valenton M. Central microbial keratitis. Philippine Journal of Ophthalmology 2000;25(1):10-21.
    • FlorCruz 2008 FlorCruz NV, Peczon IV. Medical interventions for fungal keratitis. Cochrane Database of Systematic Reviews 2008, Issue 1. [DOI: 10.1002/14651858.CD004241.pub2]
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