SYSTEMATIC REVIEW AND META-ANALYSIS INVOLVING THE MANAGEMENT OF FUNGAL KERATITIS

Fungal keratitis represents a diagnostic challenge owing to its challenging and often subtle clinical presentation. Bacterial and fungal keratitis present similarly and this renders diagnosis a clinical and therapeutic challenge especially at first presentation. 

While topical natamycin remains at the cornerstone of accepted medical management, the focus of this paper is to consider alternative and/or adjunctive anti- fungal agents in the management of Fusarium keratitis.

The underlying objective of this research is to compile a series of randomised controlled trials with proven Fusarium keratitis cases and then critically appraise each individual trial with attention towards optimal treatment paradigms for Fusarium keratitis.

A retrospective review of the existing randomised controlled trial data comparing medical and surgical treatments in proven cases of Fusarium keratitis was undertaken.

This involved a robust evaluation of the existing literature providing a comprehensive approach to answering the research question. A systematic review of the literature yielded 12 relevant studies which were deemed suitable for inclusion.

Selection of studies

Titles and abstracts resulting from the searches were assessed independently against the inclusion criteria for the review. We obtained full copies of the studies that met the inclusion criteria for further assessment on whether the paper should be included or excluded.

Search strategy

Our search strategy was entirely electronic in nature and involved the application of suitable mesh terms using three distinct search engines as described below. The search terms across all mentioned databases included: ‘fusarium keratitis’, ‘fusarium’, ‘keratitis’, ‘fungal infections’, ‘natamycin’, ‘voriconazole’ and ‘anti-infective therapy’.

Firstly, a systematic search of CINAHL, EMBASE and PUBMED (MEDLINE) was conducted using a structured strategy designed exclusively to retrieve certain studies. This protocol was produced based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA).

The results yielded in this research study advocated for topical natamycin therapy compared to voriconazole in the management of Fusarium keratitis. A deep insight into the studies and meta-analysis is further described in the presentation.

These studies have shown consistent outcomes with topical natamycin producing superior results compared to voriconazole therapy. However, there are noteworthy limitations which include differing patient demographics, bias within study design and variations in data collection techniques.

Overall, the consistent evidence in this review highlights topical natamycin as a superior agent to topical voriconazole in the management of this condition. It takes efficacy and safety into account and multiple trials have proven its superior effect.