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

Ting, Darren Shu Jeng; Henein, Christin; Said, Dalia G.; Dua, Harminder S.

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 (− 4.08days; 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 1month 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 6months 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.

Citation

Ting, D. S. J., Henein, C., Said, D. G., & Dua, H. S. (2021). Amniotic membrane transplantation for infectious keratitis: a systematic review and meta-analysis. Scientific Reports, 11, Article 13007. https://doi.org/10.1038/s41598-021-92366-x

• Journal Article Type: Article
• Acceptance Date: May 31, 2021
• Online Publication Date: Jun 21, 2021
• Publication Date: Jun 21, 2021
• Deposit Date: Jun 10, 2021
• Publicly Available Date: Jun 21, 2021
• Journal: Scientific Reports
• Electronic ISSN: 2045-2322
• Publisher: Nature Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 11
• Article Number: 13007
• DOI: https://doi.org/10.1038/s41598-021-92366-x
• Public URL: https://nottingham-repository.worktribe.com/output/5653896
• Publisher URL: https://www.nature.com/articles/s41598-021-92366-x
• Additional Information: Received: 20 March 2021; Accepted: 31 May 2021; First Online: 21 June 2021; : The authors declare no competing interests.