title: Medical interventions for fungal keratitis.
abstract: 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.
  
  
  OBJECTIVE
  To examine the effect of different antifungal drugs in the management of fungal keratitis.
  
  
  METHODS
  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.
  
  
  METHODS
  We included all relevant randomised controlled trials (RCTs) on medical therapy for fungal keratitis.
  
  
  METHODS
  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.
  
  
  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.
  
  
  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.
authors.affiliation: Department of Ophthalmology and Visual Sciences, University of the Phillipines-Philippine General Hospital, Manila, Philippines.
authors.forename: Nilo Vincent
authors.initials: NV
authors.lastname: FlorCruz
authors.forename: Ildefonso V
authors.initials: IV
authors.lastname: Peczon
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Evans
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use*; D015821:Eye Infections, Fungal / Q000188:drug therapy*; D006801:Humans; D007634:Keratitis / Q000188:drug therapy* / Q000382:microbiology; D016032:Randomized Controlled Trials as Topic
chemical_list: D000935:Antifungal Agents