Introduction
Methods
Protocol
Literature search
Eligibility criteria
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Primary outcome: The duration of corneal healing performed, characterized as thorough corneal re-epithelialized and corneal infiltration and/or hypopyon eradication
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Secondary outcome: The size of corneal epithelial defect at 1 week, the size of corneal infiltrate at 1 week, the depth of corneal infiltrate at final follow-up, visual acuity (mean logarithm of the minimum angle of resolution) at final follow-up, and adverse events: worsening infectious keratitis and/or corneal melt requiring tectonic or therapeutic keratoplasty or evisceration at final follow-up (1 to 6 months).
Exclusion criteria
Study selection
Data extraction
Risk-of-bias assessment
Data synthesis and analysis
Certainty of evidence
Results
Trial selection
Trial characteristics
Trial | Sample size (T/C) | Age, years (T/C) | Male gender (%) | Diagnosis | Follow-up |
Bamdad et al. (2015) [34] | 16/16 | 39.6 ± 16.8/40.3 ± 14.9 | 21 (66%) | BK | 1 month |
Uddaraju et al. (2015) [35] | 6/7 | 39.5 (35–41)/56 (40–62) | 8 (61%) | FK | 6 weeks |
Kasetsuwan et al. (2016) [36] | 15/15 | 44.60 (17–73)/53.93 (15–84) | 21 (70%) | BK/FK (12/18) | 1 month |
Wei et al. (2019) [11] | 21/20 | 53.4 ± 2.65/54.75 ± 3.67 | 26 (63%) | FK | 6 months |
Prajna et al. (2020) [12] | 55/56 | 55 (47, 65), 56 (45, 65)/50 (36, 55), 45 (40, 58) | 63 (57%) | FK | 3 months |
Jeyalatha et al. (2021) [13] | 9/11 | 49 ± 13.3/50 ± 9.1 | 16 (80%) | FK | 1 month |
Prajna et al. (2021) [14] | 17/19 | 59 (48–66)/60 (54.5–65) | 21 (58%) | BK | 3 months |
Trial | PACK-CXL treatment protocol | SAT regimen | |||
Bamdad et al. (2015) [34] | The same day before SAT | 365 nm × 3 mW/cm2 × 30 min | Cefazolin, gentamicin | ||
Uddaraju et al. (2015) [35] | After SAT for 2 weeks | 370 nm × 3 mW/cm2 × 30 min | Natamycin, voriconazole | ||
Kasetsuwan et al. (2016) [36] | The same day before SAT | 365 nm × 3 mW/cm2 × 30 min | Cefazolin, amikacin; amphotericin B, natamycin | ||
Wei et al. (2019) [11] | The same day before SAT | 365 nm × 3 mW/cm2 × 30 min | Natamycin, voriconazole | ||
Prajna et al. (2020) [12] | Within 24 h of enrollment | 365 nm × 3 mW/cm2 × 30 min | Natamycin, voriconazole | ||
Jeyalatha et al. (2021) [13] | Not reported | 370 nm × 3 mW/cm2 × 30 min, 5.4 J/cm2 | Natamycin, voriconazole/amphotericin B | ||
Prajna et al. (2021) [14] | Within 24 h of enrollment | 365 nm × 3 mW/cm2 × 30 min | Moxifloxacin |
Risk of bias
The duration of corneal healing performed
The size of corneal epithelial defect (mm2) at 1 week
The size of corneal infiltrate (mm2) at 1 week
The depth of corneal infiltrate (μm) at final follow-up
Visual acuity (mean logarithm of the minimum angle of resolution) at final follow-up
Adverse events
Quality of evidence
Certainty assessment | No. of patients | Effect | Certainty | Importance | ||||||||
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No. of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | PACK-CXL + SAT | SAT | Relative (95% CI) | Absolute (95% CI) | ||
The duration of corneal healing performed | ||||||||||||
2 | Randomized trials | Seriousa | Not serious | Not serious | Seriousb | None | 27 | 25 | - | MD 1.13 lower (0.183 lower to 0.42 lower) | ⨁⨁◯◯ Low | Critical |
Adverse events in fungal keratitis | ||||||||||||
4 | Randomized trials | Seriousa | Not serious | Not serious | Seriousb | None | 21/91 (23.1%) | 32/94 (34.0%) | RR 0.78 (0.38 to 1.60) | 75 fewer per 1000 (from 211 fewer to 204 more) | ⨁⨁◯◯ Low | Critical |
Adverse events in bacterial keratitis | ||||||||||||
2 | Randomized trials | Seriousa | Not serious | Not serious | Seriousb | None | 2/33 (6.1%) | 6/35 (17.1%) | RR 0.36 (0.08 to 1.71) | 110 fewer per 1000 (from 158 fewer to 122 more) | ⨁⨁◯◯ Low | Critical |