Medical interventions for fungal infection of the clear front part of the eye (cornea)

FlorCruz NV, Peczon IV, Evans JR

Published Online:

February 15, 2012

Fungal keratitis (fungal infection of the cornea) occurs rarely in higher income countries but is relatively common in lower income countries. If left untreated the cornea may perforate and may lead to blindness. Although there are a number of medications available, it is not clear which is the most effective and cost-effective. This review identified nine randomised controlled trials with 568 participants using different combinations of antifungal drugs. The trials were mainly conducted in India; they were small and of variable quality. Although there were some observed differences, these could have occurred by chance; none of the studies were large enough to determine conclusively which agents work best. Further trials with a larger sample size are required in order to answer this important question.

Abstract (click to read)

Background:

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.

Objectives:

To examine the effect of different antifungal drugs in the management of fungal keratitis.

Search strategy:

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.

Selection criteria:

We included all relevant randomised controlled trials (RCTs) on medical therapy for fungal keratitis.

Data collection and analysis:

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.

Main results:

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.

Authors' conclusions:

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.

This record should be cited as:

FlorCruz NV, Peczon IV, Evans JR. Medical interventions for fungal keratitis. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD004241. DOI: 10.1002/14651858.CD004241.pub3

Assessed as up to date:

August 29, 2011

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Primary Review Group:

Eyes and Vision Group

Health topics:

Infectious disease > Eye diseases > Keratitis

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Medical interventions for fungal infection of the clear front part of the eye (cornea)

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