Topical Management Of Corneal Subepithelial Infiltrates: A Systematic Review And Network Meta-Analysis
Published 2026 - 44th Congress of the ESCRS
Reference: POCOR242 | Type: Free paper | DOI: 10.82333/3za4-4m73
Authors: Dr Margarita Safir* 1 , Dr Nevo Kovalis 2 , Prof. Michael Mimouni 3 , Dr Dror Ben Ephraim Noyman 3
1Rabin Medical Center,Petah Tikva,Israel, 2Ruth and Bruce Rappaport Faculty of Medicine, Technion ,Haifa,Israel, 3Ruth and Bruce Rappaport Faculty of Medicine, Technion ,Haifa,Israel;Rambam Health Care Campus,Haifa,Israel
Purpose
To compare the relative efficacy and safety of topical therapies for corneal subepithelial infiltrates (SEIs) following adenoviral keratoconjunctivitis using a network meta-analysis of randomized controlled trials (RCTs).
Setting
Systematic review and network meta-analysis of RCTs.
Methods
A comprehensive search of PubMed/MEDLINE, Scopus, and Embase was performed from inception to October 20, 2025. RCTs evaluating topical pharmacologic treatments for adenoviral SEIs were included. Acute-phase conjunctivitis studies and non-randomized designs were excluded. Treatments were synthesized using a frequentist random-effects network meta-analysis (netmeta, R). Standardized mean differences (SMDs) were used for continuous outcomes and odds ratios (ORs) for recurrence; treatments were ranked using P-scores. Outcomes included SEI resolution, visual acuity, symptoms, recurrence, intraocular pressure (IOP), and adverse events.
Results
Six RCTs (329 patients) were included. Tacrolimus ranked highest for SEI resolution and was the only intervention significantly superior to topical steroids (SMD −2.66; 95% CI −4.78 to −0.55). Tacrolimus also ranked first for visual acuity improvement, with cyclosporine A (CsA) ranking second. Steroid-based regimens ranked highest for recurrence prevention and symptom improvement. No statistically significant differences were detected for IOP across treatments. Adverse event reporting was limited; no serious treatment-related adverse events were identified.
Conclusions
Tacrolimus demonstrated the greatest overall effectiveness for SEI resolution and visual acuity improvement. These findings support its role as a key steroid-sparing option in the management of adenoviral SEIs. Larger, well-designed trials are needed to refine treatment algorithms for adenoviral SEIs.