Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

Abstract Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine...

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Autores principales:	Darren Shu Jeng Ting, Christin Henein, Dalia G. Said, Harminder S. Dua
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/c164ba482cbd4f2a926fa82b7141aff6
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spelling	oai:doaj.org-article:c164ba482cbd4f2a926fa82b7141aff62021-12-02T18:02:49ZAmniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis10.1038/s41598-021-92366-x2045-2322https://doaj.org/article/c164ba482cbd4f2a926fa82b7141aff62021-06-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-92366-xhttps://doaj.org/toc/2045-2322Abstract Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (− 4.08 days; 95% CI − 6.27 to − 1.88; p < 0.001) and better UDVA (− 0.26 logMAR; − 0.50 to − 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46–1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.Darren Shu Jeng TingChristin HeneinDalia G. SaidHarminder S. DuaNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-15 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Darren Shu Jeng Ting Christin Henein Dalia G. Said Harminder S. Dua Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
description	Abstract Infectious keratitis (IK) is the 5th leading cause of blindness globally. Broad-spectrum topical antimicrobial treatment is the current mainstay of treatment for IK, though adjuvant treatment or surgeries are often required in refractory cases of IK. This systematic review aimed to examine the effectiveness and safety of adjuvant amniotic membrane transplantation (AMT) for treating IK. Electronic databases, including MEDLINE, EMBASE and Cochrane Central, were searched for relevant articles. All clinical studies, including randomized controlled trials (RCTs), non-randomized controlled studies and case series (n > 5), were included. Primary outcome measure was time to complete corneal healing and secondary outcome measures included corrected-distance-visual-acuity (CDVA), uncorrected-distance-visual-acuity (UDVA), corneal vascularization and adverse events. A total of twenty-eight studies (including four RCTs) with 861 eyes were included. When compared to standard antimicrobial treatment alone, adjuvant AMT resulted in shorter mean time to complete corneal healing (− 4.08 days; 95% CI − 6.27 to − 1.88; p < 0.001) and better UDVA (− 0.26 logMAR; − 0.50 to − 0.02; p = 0.04) at 1 month follow-up in moderate-to-severe bacterial and fungal keratitis, with no significant difference in the risk of adverse events (risk ratio 0.80; 0.46–1.38; p = 0.42). One RCT demonstrated that adjuvant AMT resulted in better CDVA and less corneal vascularization at 6 months follow-up (both p < 0.001). None of the RCTs examined the use of adjuvant AMT in herpetic or Acanthamoeba keratitis, though the benefit was supported by a number of case series. In conclusion, AMT serves as a useful adjuvant therapy in improving corneal healing and visual outcome in bacterial and fungal keratitis (low-quality evidence). Further adequately powered, high-quality RCTs are required to ascertain its therapeutic potential, particularly for herpetic and Acanthamoeba keratitis. Future standardization of the core outcome set in IK-related trials would be invaluable.
format	article
author	Darren Shu Jeng Ting Christin Henein Dalia G. Said Harminder S. Dua
author_facet	Darren Shu Jeng Ting Christin Henein Dalia G. Said Harminder S. Dua
author_sort	Darren Shu Jeng Ting
title	Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
title_short	Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
title_full	Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
title_fullStr	Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
title_full_unstemmed	Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
title_sort	amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/c164ba482cbd4f2a926fa82b7141aff6
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Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis

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